tracelogoRB Reference Guide for First Choice VIP Care Plus 

 

The Select Health First Choice VIP Care Plus Quick Reference Guide provides information regarding the First Choice VIP Care Plus plan, its members, claims, and Select Health policies. The information in this section is in addition to the HNS/Payor Policies.

 

This Quick Reference Guide contains the following information specific to First Choice VIP Care Plus.

 

General Information

 

Verifying Eligibility 

 

Prior Authorization

 

Referral System

 

Submitting Claims for First Choice VIP Care Plus Members

 

Corrected Claims

 

Claims Inquiries

 

Provider Relations

 




General Information 

 

First Choice (Medicaid/Medicare)

 

Select Health First Choice VIP Care Plus is a SC Medicare/Medicaid managed care plan.

 

Important Facts about First Choice VIP Care Plus:

  1. No preauthorization is required for VIP Care Plus members for chiropractic care.
  2. There is no limit on the number of annual visits allowed, provided visits are medically necessary.
  3. Referral from PCP is recommended but is NOT required.
  4. Primary diagnosis for all Select Health claims must be a subluxation code.
  5. Claims must show First Choice VIP Care Plus in box 11c.
  6. Claims cannot be submitted electronically. (Submit all claims via paper using the CMS 1500 Claim Form.)
  7. Coverage is limited to the following manipulation codes. 
Procedure Code Code Description
98940 Chiropractic Manipulation; Spinal, one to two regions
98941 Chiropractic Manipulation; Spinal, three to four regions
98942 Chiropractic Manipulation; Spinal, five regions

 

Please do not send claims directly to Select Health. All First Choice VIP Care Plus claims must be sent to HNS, and must be sent via paper claims.

 

If you have any questions about Select Health First Choice VIP Care Plus, please email your HNS Service Representative for assistance before calling Select Health.

 

 

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Verifying Eligibility 

 

Be sure to verify eligibility for each Select Health First Choice VIP Care Plus member.

 

To verify eligibility, refer to the telephone number on the member's identification card.

 

HNS' managed care partners list the HNS "participating providers" under the HNS master tax number/NPI in their systems and to obtain accurate information when verifying eligibility or benefits, you must use the HNS EIN and/or NPI.

 

Use the HNS EIN and/or HNS NPI number when verifying eligibility.

  1. The HNS EIN is 56-1971088
  2. The HNS NPI number is 1093773392

 

 

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Prior Authorization

 

Prior authorization is NOT required for services provided to First Choice VIP Care Plus members.

 

  

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Referrals from PCPs 

 

First Choice VIP Care Plus recommends that provider obtain a referral from their primary care physician for chiropractic care, but this in not required.

 

  

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Submitting Claims for First Choice VIP Care Plus Members 

 

Where to Send Claims for First Choice VIP Care Plus Members:

All Select Health First Choice VIP Care Plus claims must be sent to HNS. Please do not send claims directly to Select Health. Claims submitted directly to Select Health will process incorrectly and will have to be refiled.

 

Please ignore the claims billing address on the member ID card or any address given to you on the telephone when verifying eligibility and benefits. All Select Health First Choice VIP Care Plus claims must be sent to HNS.

 

How to File Claims

Please review the HNSConnect® User Manual for important and helpful information regarding filing claims to HNS.

 

All Select Health claims (even when filing claims electronically) must be identified as a Select Health claim in the address section at the top of the CMS 1500 claim form (HNS/Select Health is an acceptable format) using the example address below:

 

Example:  HNS/Select Health
                 PO Box 2368
                 Cornelius, NC 28031

 

  • At this time, First Choice VIP Care Plus claims cannot be submitted electronically to HNS.
  • All primary claims for First Choice VIP Care Plus members must be sent to HNS as paper claims using the CMS 1500 claim form.
  • All corrected and secondary claims must be sent to HNS as paper claims using the CMS 1500 claim form.

 

Required Information for Claims

  • Primary diagnosis for all Select Health claims must be a subluxation diagnosis.
  • Claims must show First Choice VIP Care Plus in box 11c.
  • If you receive a referral from the PCP, box 17 must be completed.

 

 

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Corrected Claims

 

When filing corrected claims to Select Health, claims must include the following:

  • The claim must include the words "Corrected Claim" at the top of the claim.
  • Box 22 (Resubmission code) - under this heading, you must include the #7 which indicates the claim is a corrected claim.
  • Box 22 (Original ref. no.) - under this heading, instead of the reference number of the original claim, you must include the reference number shown on the most recently adjudicated claim. (Contact your HNS Service Rep if you cannot locate the reference number.)

 

Please see an example of a corrected claim (in the red vertical menu for Select Health First Choice VIP Care Plus) and use this as a guide to ensure you correctly create the claim.

 

 

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Claims Inquiries

 

As previously noted, HNS' managed care partners list the HNS "participating providers" under the HNS master tax number/NPI in their systems and to obtain accurate information when verifying eligibility or benefits, you must use the HNS EIN and/or NPI.

 

If you contact a payor directly (to obtain preauthorization, verify benefits or to trace a claim) and you are told that you are "out-of-network", use the HNS master federal tax number (EIN) and/or HNS' NPI instead of your own.

 

The HNS EIN is 56-1971088.

 

The HNS NPI number is 1093773392.

  

For tracing outstanding claims (after 60 days from your billing date), please email your HNS Service Rep and include the patient name, date of birth, member ID number and the dates of service in question. We will gladly trace the claim for you and will respond back to you within 3-5 business days.

 

Resubmit lost/missing claims through HNS.

 

 

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Provider Relations 

 

Questions relating to your participation in Select Health should be directed to your HNS Service Representative. Your HNS Service Rep's email address is displayed on the provider dashboard on the secure section of the HNS website.

 

 

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