Claim Filing Procedures/Claim Payments

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

Claims should be submitted to:

HP Administrative Services, LLC
P.O. Box 24870
Oklahoma City, OK 73124

Correspondence should be submitted to:

HP Administrative Services, LLC
P.O. Box 24110
Oklahoma City, OK 73124

Acceptable claim forms are:

CMS 1500
UB-04
American Dental Association 2006

Click here for detailed information regarding how to file claims with HealthChoice.

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

ClaimLink

ClaimLink is a valuable feature of the HealthChoice Network Provider Home Page. With ClaimLink, Network Providers have online access to check the status of medical and dental claims, to check deductible status, to confirm member eligibility and access claim editing rationale. ClaimLink 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 Center for Medicaid and Medicare Services (CMS).

In order to ensure privacy, first-time users must register and create a User ID and Password. The provider’s email address and TIN will be required to register. The User ID and Password is necessary for future access.

Direct Data Entry

Within ClaimLink, providers have the ability to submit individual claims without any intermediary software through the direct data entry feature. The direct data entry feature allows providers to submit individual medical, dental or hospital claims directly to the claims administrator. The provider receives an immediate response regarding the status of the claim with real time responses indicating if the claim has been paid, denied or suspended.

Electronic Claims Submissions

Clearinghouses

Providers are able to submit claims electronically utilizing acceptable clearinghouses as identified by HP. Contact HP directly for more information.

All claims are paid directly to Network Providers as required under the terms of the Contract.

Example of the Provider Remittance Advice

HealthChoice Network Providers currently accepting Medicare assignment will receive direct claims payments.

Electronic Funds Transfer

Electronic Funds Transfer (EFT) is utilized for all provider payments. The EFT method of payment eliminates the need for the manual processing of checks. EFT also ensures security and expedites claim payments to the providers.

Checks and Remittance Advices are processed for Network Providers on a nightly basis. Payments are deposited into the provider’s bank account the next business day. Remittance Advices are mailed to the provider from Oklahoma City the same day as the EFT deposit.

If you have questions or you need more information about EFT, contact HP for assistance.

Combined Payments

Combined Payments are utilized for all providers. Under the Combined Payments feature, all payments for a given day are combined into a single Remittance Advice which is issued to the provider on a daily basis. Combined Payments should facilitate the processing of claim payments by the provider.

If you have questions or you need more information about Combined Payments, contact HP for assistance.