tracelogoRB Reference Guide for Select Health First Choice (Medicaid)

 

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

 

General Information

 

Verifying Eligibility 

 

Prior Authorization

 

Referrals from PCPs

 

Submitting Claims for First Choice Members

 

Corrected Claims

 

Claims Inquiries

 

Provider Relations

 



General Information

 

First Choice (Medicaid)

 

Important Facts about First Choice: 

  1. Preauthorization is REQUIRED only for patients 18 yrs old and younger.
  2. Coverage is limited to six visits per year. (Year is July 1st to June 30th)
  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 include First Choice in box 11c.
  6. Claims must include the preauthorization number in box 23.
  7. Primary claims must be submitted electronically to HNS.
  8. Coverage is limited to the following manipulation and x-ray codes. (First Choice does not cover physical therapies or modalities.)

 

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
72040 Spine; Cervical, Anteroposterior and Lateral
72050 Spine; Cervical, Minimum of four views
72070 Spine; Thoracic, Anteroposterior and Lateral
72080 Spine; Thoracolumbar, Anteroposterior and Lateral
72082 Spine; Thoracic and Lumbar, including skull, cervical and
sacral, two or three views
72100 Spine; Lumbrosacral, Anteroposterior and Lateral

 

Please do not send claims directly to Select Health. All Select Health First Choice claims must be sent to HNS. 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.

 

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

 

 

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Verifying Eligibility

 

Always verify eligibility for each Select Health First Choice 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 ONLY required for services provided to First Choice members who are under the age of 18.

 

If required, the authorization number must be included in Box 23 on the claim form.

 

To obtain prior authorization for First Choice patients, please call Select Health:  (888) 559-1010.

 

Select Health First Choice may take up to 14 days to give authorization to treat. If the care needed is urgent, you should so indicate when you call for authorization and Select Health, assuming the member is eligible for chiropractic care at that time, will expedite the authorization.

 

HNS' managed cared partners list the HNS "participating providers" under the HNS master tax number/NPI in their systems and to obtain preauthorization, you must use the HNS EIN and/or NPI.

 

Always use the HNS EIN and/or HNS NPI number to obtain preauthorization.

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

  

When filing claims, the prior authorization number must be included in box 23 of the CMS 1500 form.

 

Newly Credentialed Providers:

If you are a newly credentialed provider, you may not be able to obtain the required pre-authorization for the first 30 days following the effective date of your participation in the HNS Network. Select Health's provider system will not be able to identify you as an "in-network" provider during that time and has asked that you wait the first 30 days before rendering services to Select Health members.

 

NOTE:  Obtaining a prior authorization number is no guarantee of patient eligibility and benefits. You must first call to verify eligibility and benefits before obtaining a prior authorization number.

 

 

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Referrals from PCPs 

 

First Choice recommends that providers obtain a referral from their primary care physician for chiropractic care but this is not required

 

 

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Submitting Claims for First Choice Members 

 

Where to Send Claims for First Choice Members:

All Select Health First Choice 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 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

 

  • All primary claims for First Choice patients should be submitted electronically to HNS.
  • All secondary and corrected 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 in box 11c.
  • Claims must include the preauthorization number in box 23.
  • 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) 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/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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