Presentation on theme: "The Wellness Division of This program is designed to help our members identify their health risks and take steps to improve their health."— Presentation transcript:
The Wellness Division of
This program is designed to help our members identify their health risks and take steps to improve their health.
Eligible HealthChoice members must: Complete their free comprehensive preventive services visit Complete their free comprehensive metabolic and lipid panels Complete their health risk assessment
Eligible Providers must: Participate in the HealthChoice Provider Network Provide services in an outpatient or medical setting Bill the designated CPT Codes for 100% reimbursement of Allowed Charges
New Patient – Initial Comprehensive Preventive Medicine Exam 99385 – patient age 18-39 99386 – patient age 40-64 99387 – patient age 65+ (non-Medicare)
Established Patient – Comprehensive Preventive Medicine Exam 99395 – patient age 18-39 99396 – patient age 40-64 99397 – patient age 65+ (non-Medicare)
Metabolic Panel 80053 – comprehensive metabolic panel or 80050 – general health panel Lipid Panel 80061 – comprehensive lipid panel
When you use the CPT Codes designated for the H.E.L.P. program, services are covered once per calendar year at 100% of the HealthChoice Allowed Charges, regardless of the patient’s diagnosis. There is no copay or other out-of-pocket cost to the HealthChoice member.
Multiple procedures/codes can be billed at the same time as the free preventive exam; however, additional services outside the H.E.L.P. program are subject to all Plan provisions including deductibles, copays, and coinsurance.
Biometric Results Height and weight Blood pressure (systolic/diastolic) Resting heart rate (pulse) Lab Results Fasting blood glucose Fasting LDL, HDL, and total cholesterol Fasting triglycerides
Certain preventive services are now covered at 100% of the HealthChoice Allowed Charges. Members must meet specific criteria including age, sex, policy limits, and diagnosis and procedure codes. Eligible members have no copay or other out-of- pocket costs. A list of these preventive services, including criteria, can be found on the HealthChoice Provider Website under Quick Links.
If you have questions or need additional information, please contact HP Administrative Services, LLC at 1- 405-416-1800 or toll free 1-800-782- 5218.