Claim Submissions

ClaimLink

ClaimLink is a valuable feature of the HealthChoice Network Provider homepage. With ClaimLink, Network Providers can file claims online through direct data entry without the need for intermediary software. ClaimLink provides access to claims status the business day following submission. ClaimLink also gives providers the ability to check real time deductibles, out-of-pocket maximums, confirm member eligibility, obtain a Remittance Advice (RA) and access claim editing rationale; however, it does not currently provide editing rationale for outpatient facility claims. Outpatient facility claims are edited using the Outpatient Code Editor (OCE) as published by the Centers for Medicaid and Medicare Services (CMS). (Also see ClaimCheck and Clear Claim Connection.)

Next business day claim status check and instant access to RAs through a secure provider ClaimLink account can help improve revenue-cycle management reducing the lag time between an electronic funds transfer and receipt of the RA in the mail. Instant access to an RA can also help to speed up account reconciliation processes.

In order to ensure privacy, first-time users must register and create a User ID and password. The provider’s email address and TIN are required to register. The User ID and password are necessary for future access.
Quick start guides are available on the ClaimLink homepage with no login required. The guides provide tutorials that include step-by-step processes for submitting claims, searching claims, and obtaining RAs online. Adobe Reader is required to view the guides.

Corrected claims cannot be submitted electronically or online through ClaimLink. Hard copies of corrected claims must be submitted to the correspondence address for the Claims Administrator. Access to ClaimLink is available at the link at the top of this page.

Clearinghouses

Providers can submit claims electronically utilizing clearinghouses in conjunction with the electronic claims payer ID 22521. Contact the claims administrator for more information.

All electronic transactions must conform to HIPAA 5010 standards. Claims that are not in compliance are either rejected or denied.

Corrected claims cannot be submitted electronically. Hard copies of corrected claims must be submitted to the correspondence address of the claim administrator.

Paper Claims Submissions

Under the terms of the Network Provider Contract, HealthChoice Network Providers are required to file claims for HealthChoice members.

Claims should be submitted to:

HP Administrative Services, LLC
PO Box 24870
Oklahoma City, OK 73124

Correspondence and corrected claims should be submitted to:

HP Administrative Services, LLC
PO Box 24110
Oklahoma City, OK 73124

Acceptable claim forms are:

CMS 1500
UB-04
ADA 2012

All claims must be submitted on the most current version of the appropriate claim form. For detailed information regarding how to file claims or information about the latest claim forms, consult the HealthChoice Provider Billing Guides on this site.

Regardless of the claim form utilized, claims are processed according to the appropriate fee schedule.