OSEEGIB is excited to announce that all Network Dentists can now file claims online through ClaimLink. ClaimLink is an online service available through each Network Provider website.
Many providers have already used ClaimLink to verify member eligibility and check the status of claims. Online claim submission is a much more efficient method of submitting claims. It significantly reduces processing errors and improves the turnaround time for claim payments. A presentation that outlines the online claims submission process is available once you log into ClaimLink. If you have additional questions, please contact HP Administrative Services, LLC. at 1-405-416-1800 or toll-free 1-800-782-5218.
For additional training please contact Kelli Smith at 1-405-416-1504. OSEEGIB is also available to provide assistance at 1-405-717-8790 or toll-free 1-800-543-6044.
For security purposes, you must register to obtain a unique username and password to use ClaimLink. If you have previously registered for ClaimLink, it is not necessary to re-register to file claims online.
We would like to apologize for the numerous letters that were recently mailed requesting certification documentation and the inconvenience this may have caused. The letters were produced on a line item level instead of a claim level which is why you received several letters for one claim.
If you received any of these letters, please follow the instructions at the bottom for fastest resolution. If certification was previously obtained from OSEEGIB, you may contact HP at 1-405-416-1800 or toll-free 1-800-782-5218.
OSEEGIB hereby clarifies the intent of Network Provider contract articles relating to certification/ utilization review requirements:
Effective January 1, 2010, as soon as an outpatient procedure or inpatient admission has been certified and approved, the provider has met the conditions of the contract, and the procedure can be performed immediately. It will not be necessary to wait the three-day period before services may be provided.
Provider Relations has been contacted by providers with questions about coverage for Consultation Codes. These questions have been generated by the Medicare/CMS decision to discontinue payment for the services designated by these codes effective 1-1-10. The consultation CPT codes include the inpatient codes (99251-99255) and office/outpatient codes (99241-99245). Since Medicare will not pay for the services reported by these codes in 2010, the HealthChoice Medicare Supplement Plans will not cover these codes beginning 1-1-10.
HealthChoice will continue to recognize these codes as valid for payment for the HealthChoice High Option, Basic, and S-Account Plans.
CPT and HCPCS codes have been added to the HealthChoice and DOC fee schedules effective 11-1-09 for the H1N1 Virus vaccine and its administration. These three codes are as follows:
Providers will be sent 1099 forms under the names registered by the Internal Revenue Service on the 1099 windows and as indicated on the W-9 forms. Only one 1099 will be distributed for each tax identification number (TIN). If multiple providers share the same TIN, only one 1099 will be prepared and sent. The 1099 is mailed to the address indicated on the W-9 form submitted to cover each provider sharing a single TIN.
The allowable for CPT code 41899 has been updated to $1,566 in an Ambulatory Surgery Center setting. The original fee schedule amount of $80 was not appropriate and we are taking this opportunity to correct the previous fee allowed by the Plan. The fee schedule that is included in the ASC contract (See Contracts/Appl in the menu at left) has also been updated to reflect the most current allowable for code 41899.
In addition to updating the fee schedule, claims reimbursed at the erroneous fee have been adjusted to allow the revised fee schedule. You will be notified of the adjustment through your Provider Remittance statements.
In an effort to increase the efficiency and accuracy of claims processing, effective September 1, 2009, non-standard claims will no longer be accepted. All claims that are not submitted on the proper claim form, or forms that are incomplete, will be returned. Inappropriate claim forms include, but are not limited to superbills, copies of receipts, or printed reports generated from practice management software.
Visit the following web sites to access the appropriate claim forms or for more information on proper billing procedures.
Claim forms sent by FAX will no longer be accepted.
The FHH overpayments that were scheduled to be recouped from claim payments starting 9/1/09 are now in the process of being recouped. These adjustments are identified by the Accounts Receivable reason code “FHOV” which is located at the bottom of the Provider Remittance.
Please call HP at 1-405-416-1800 or toll-free 1-800-782-5218 if you have unresolved overpayment issues from FHH or to obtain details regarding the original claim payment(s) involved in the recoupment. The following are the phone prompts on the HP customer service call line which will connect you to the overpayment team for assistance:
Oklahoma State Statutes require interest to be paid to providers when clean claims are not processed within 45 days of receipt. In accordance with this requirement, the Oklahoma State and Education Employees Group Insurance Board, through its third party claims administrator, HP is paying interest for claims that meet the criteria required in the State Statues.
Prospective interest payments began on April 8, 2009. All claims paid on or after that date included interest payments if the claim was not processed and paid within the mandated 45 day period.
Recently, retrospective interest payments were initiated. Providers were sent communication through the mail with instructions on how to initiate the process of receiving interest for older claims. The process of distributing retrospective interest is being handled in three phases.
Questions and Answers regarding interest payments can be found using the Interest Payment Questions and Answers link following this article.
Any additional questions you may have concerning interest payments should be directed to HP Administrative Services, LLC. at 1-405-416-1780 or toll-free 1-800-782-5218.
Interest Payment Questions and AnswersOrthodontic Services are paid by the Plan at the established benefit level when the banding has been performed. The orthodontist is expected to file a claim for the services performed at the time the service is rendered. The Plan does not pay claims based on payment installments.
A small percentage of Orthodontists are filing claims with future billing dates. Claims with future billing dates will not be accepted and will be denied.
If you have any questions regarding the processing and payment of claims for orthodontic services, please contact HP Administrative Services, LLC. customer service at 1-405-416-1800 or toll free 1-800-782-5218.
