Reference Guide for First Choice VIP Care 

Effective January 1, 2022, HNS' contract with Select Health will include Select Health's First Choice VIP Care plan.

The Select Health First Choice VIP Care Quick Reference Guide provides information regarding the First Choice VIP Care 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.

General Information

Verifying Eligibility 

Prior Authorization

Referral System

Copayments

First Choice VIP Care ID Cards

Submitting Claims for First Choice VIP Care Plus Members

Corrected Claims

Claims Inquiries

Provider Relations

General Information 

First Choice VIP Care (D-SNP Plan)

This is a new Medicare Advantage (MA) dual-eligible special needs plan (D-SNP) for South Carolina residents who are eligible for both Medicare and Medicaid. Members will have First Choice VIP Care, as well as separate Healthy Connections Medicaid policies through the State of South Carolina. First Choice VIP Care is the primary payor and Healthy Connections secondary.

As a Medicare D-SNP, First Choice VIP Care only pays for manipulations and all claims for this plan must be filed to HNS. While Healthy Connections Medicaid may cover additional services for these members, providers will need to file secondary claims for those services directly to Healthy Connections.

Important Facts about First Choice VIP Care:

1. There is no copayment for chiropractic services.
2. There is no limit on the number of annual visits allowed, provided visits are medically necessary.
3. No preauthorization is required for VIP Care members for chiropractic care.
4. Referral from PCP is NOT required.
5. Primary diagnosis for all Select Health claims must be a subluxation code. (Be sure to include the AT modifier.)
6. Claims must show First Choice VIP Care in box 11c.
7. Claims cannot be submitted electronically. (Submit all claims via paper using the CMS 1500 Claim Form.)
8. Coverage is limited to the following manipulation codes.

Please do not send claims directly to Select Health. All First Choice VIP Care 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, please email your HNS Service Representative for assistance before calling Select Health. Your HNS Service Representative's email address is displayed on the provider dashboard on the secure section of the HNS website.

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Verifying Eligibility 

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

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Referrals from PCPs 

Referrals from the members' Primary Care Providers are not required.

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Copayments

The First Choice VIP Care plan has a zero-dollar copayment.

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First Choice VIP Care ID Cards

All First Choice VIP Care claims must be submitted to HNS.

Members are easy to identify as their member ID card will clearly state "First Choice VIP Care" by Select Health of South Carolina.

Below is an example of the First Choice VIP Care subscriber ID card. When a patient presents with this card, please remember that effective 1/1/2022, you are a participating provider with the First Choice VIP Care plan through your participation with HNS.

Please remember to obtain a copy of the front and back of the insurance card and maintain this in the member's health care record.

If you are uncertain about where to file the claim, please email your HNS Service Representative a clear, legible copy of the member ID card and we will promptly respond back to you with an answer. Your HNS Service Representative's email address is displayed on the provider dashboard on the secure section of the HNS website.

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Submitting Claims for First Choice VIP Care Members 

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

Claims must show First Choice VIP Care in box 11c.

All Select Health First Choice VIP Care 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 claims must be sent to HNS.

How to File Claims: 

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 claims cannot be submitted electronically to HNS.
• All primary claims for First Choice VIP Care members 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. Just as with Medicare, please be sure to include the AT modifier.
• Claims must show First Choice VIP Care in box 11c.

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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) 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 Representative 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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