tracelogoRB Reference Guide for Select Health 

 

The Select Health of South Carolina Quick Reference Guide provides information specific to the Select Health plan and First Choice concerning Select Health claims, Select Health members, and Select Health policies. The information in this section is in addition to the HNS/Payor Policies.  The Select Health Quick Reference Guide contains the following information specific to Select Health and provides you with helpful information regarding your Select Health claims.

 

General Information

 

Eligibility/Benefits 

 

Prior Authorization

 

Referral System

 

Claims Submission

 

Corrected Claims

 

Claims Inquiries

 

Provider Relations

 




General Information

 

Select Health has two plans:

 

            1. First Choice (Medicaid)

Requires pre-authorization.

Limited to 6 visits per year.

Limited to spinal manipulations only.

No physical therapy or modalities are covered.

Pre-authorization number must be in box 23 on the claim form. 

Referral from PCP is recommended but is NOT required.           

Must show First Choice in box 11c of the claim form.

Primary claims should be submitted electronically to HNS.

 

 

            2. VIP Care PLUS  (Medicaid/Medicare)

No pre-authorization is required.

No annual visit limit provided all visits are medically necessary.

Limited to spinal manipulation only.

No physical therapy or modalities are covered.

Must show First Choice VIP Care Plus in box 11c of the claim form.

ALL claims must be mailed to HNS (cannot be submitted electronically)

                            

        

Please do not send claims directly to Select Health.  All Select Health 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. You are under contract as a participating Select Health of South Carolina provider through HNS and our instructions for filing claims supersede information given to you by Select Health Representatives.

 

 

If you have any questions about a Select Health/First Choice, please contact your HNS Service Representative at (877) 426-2411 before calling Select Health.

 

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Eligibility/Benefits

 

Be sure to verify eligibility for each Select Health member.

 

Please remember to ask for specific information on chiropractic benefits for each member. CLICK HERE to see a sample Verification of Eligibility/Benefit Form.  

 

To verify eligibility and benefits - Refer to the telephone number on the member's identification card   

 

 

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Prior Authorization (only for First Choice)

 

Prior authorization is required for services provided to First Choice members but, as noted above, is NOT required for VIP Care Plus members.

 

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. 

 

 

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

 

When filing claims, the prior authorization number must be included in box 23 of the CMS 1500 form.  If you are a newly credentialed provider, you may not be able to obtain the required pre-authorization for the first 30 days from your effective date. 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.

 

 

Select Health has attached the HNS EIN to all HNS providers, so you MUST use the HNS TAX ID number (56-1971088) in order to receive in-network verification. (If you use your own EIN when verifying eligibility and benefits, you will be told you are not listed as a participating provider.)

 

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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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Claims Submission
 

 

All claims for First Choice patients should be submitted electronically to HNS.

 

All claims for First Choice VIP Care Plus must be mailed to HNS.

 

Primary diagnosis  for all Select Health claims must always be a subluxation code.

 

Please ignore any instructions regarding where to submit claims by payor phone representatives. HNS instructions regarding where to submit claims supersede all other instructions given by payor representatives when verifying eligibility and benefits.

 

In order for Select Health claims to adjudicate quickly and accurately, please note the following information regarding claims submission specific to Select Health is in addition to the HNS' instructions under Filing Claims to HNS.

 

  • If the claim is for First Choice, First Choice should be in box 11c on the claim form..
  • If the claim is for First Choice VIP Care Plus, VIP must be in box 11c on the claim form..
  • If required, the prior authorization number must be 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 21 (RESUBMISSION CODE) - under this heading, you must include the # 7 which indicates the claim is a corrected claim.
  • Box 21 (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.

 

Please see an example of a corrected claim (in the red vertical menu for Select Health).

 

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Claims Inquiries

 

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 services in question. We will gladly trace the claim for you and will respond back to you within 3 business days.

 

Resubmit lost/missing claims through HNS.

 

Refer to your HNS/Select Health fee schedule to confirm allowable amounts if prior authorization was obtained before rendering services.

 

 

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Provider Relations 

 

Questions relating to your participation in Select Health should be directed to your HNS Service Representative at (877) 426-2411.

 

 

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