PPO Network
One Union Square
600 University Street, Suite 1400
Seattle, WA 98101
(800) 231-6935
www.fchn.com
Spring 2011 - Provider Newsletter
LETTER FROM
THE PRESIDENT & CEO
Thank you for your continued participation in First Choice Health
PPO Network (FCH PPO).
2011 has been deemed the “Year
of the Provider” by staff here at First
Choice Health. Internal operations
are focused on a number of key
projects to enhance the provider
experience with First Choice Health,
as well as the payor clients that
utilize the PPO Network.
We are focused on 5010 testing
with our trading partners and
payor clients and we have made
system modifications in preparation
for ICD-10 readiness. We are
about to roll out a new website
design which we think you will
find easier to navigate. Website
tools for accessing employer
group information and key
payor information continue to be
enhanced. The Provider Manual
will also be updated in the next
couple of months.
Enhancing our EDI capabilities has
also been a focus this year. We
are working on more direct EDI
connections with payors and would
like to do the same with providers in
order to speed up claim processing
timeliness.
We are working hard to improve
your experience with First Choice
Health and appreciate your ongoing
participation in our PPO Network.
Warm Regards,
What’s in your Spring Newsletter
Letter from the President and CEO............... 1
Ken Hamm
CEO & President
First Choice Health Updated Website........... 2
GEHA helps members quit smoking
with 100% coverage.................................... 2
Group Name and Number required
on all FCHN claims....................................... 3
OneHealthPort Offers Statewide
Credentialing Services................................. 3
Payor Update .............................................. 4
Charitable Giving Foundation....................... 4
2010 Holiday Schedule ............................... 4
“State of the Network” Reporting................. 4
(800) 231-6935
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PPO Network Provider Newsletter - Spring 2011
First Choice Health Updated Website
We listened to your feedback
and have redesigned our
website to address your
concerns and needs.
Beginning mid April, our
website will have a new
look and feel, improved user
navigation and easier access
to tools and resources you
need on a daily basis.
Our new website utilizes public web pages that are available to everyone
and secure web pages that require a username and password. The public
web pages are informational and meant to educate the user and showcase
our capabilities. The secure web pages allow providers quick to access
user specific tools and resources.
Government Employees Hospital
Association (GEHA) now offers its
members 100% coverage to help
members quit once and for all – no
copays, coinsurance, deductibles or
dollar limits. These benefits apply
to all GEHA members of an FEHB
(Federal Employees Health Benefits)
plan. Covered family members are
also eligible if the GEHA member has
a Self and Family enrollment.
Providers accessing the secure web pages on our website need to register
with OneHealthPort first. Once you’ve registered with OneHealthPort and
received a username and password, you’ll be able to access the secured
FCH web pages for providers on our website.
These benefits are paid at 100% of the
plan allowable with no deductible for
in-network or out-of-network providers.
GEHA’s smoking cessation benefits cover:
You will receive additional communication closer to our launch date, with
instructions on how to access the tools and resources specific to contracted
providers of First Choice Health (FCH).
Clearing up some confusion.
First Choice Health (FCH) has four core services: a PPO Network, Benefit
Plan Administration, Medical Management and Assistance Services.
Providers interact with all four of First Choice Health’s business units, but on
different levels. First Choice Health Administrators (FCHA) is the benefit plan
administrative service of FCH. FCHA is actually a Payor utilizing the First
Choice Health PPO Network (FCH PPO). FCH PPO does not have patient
eligibility and benefit information for patients. It is up to the Payors to provide
access to patient eligibility and benefit information. As a Payor, FCHA allows
providers access to patient eligibility and benefit information for the business
FCHA administers.
Look for our website launch mailer early April!
For questions regarding the content of this bulletin, please contact FCH
PPO Provider Relations at (800) 231-6935 Ext. 2103 or via email at
[email protected].
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GEHA helps
members quit
smoking with
100% coverage
(800) 231-6935
• up to four sessions of counseling for
each attempt to quit, with two attempts
to quit covered each year;
• both over-the-counter (with a
physician’s prescription) and
prescription drugs approved for
smoking cessation.
Nicotine gum is covered, but a member
must get a prescription from his or her
doctor for it to be covered with no copays
and coinsurance.
Members can find an in-network provider
to prescribe cessation medication or
to provide counseling by using GEHA’s
online Provider Search on www.geha.com.
For more on GEHA’s smoking cessation
benefits, please see the GEHA Plan
Brochure, which is available online at
www.geha.com, or call GEHA Customer
Service at (800) 821-6136.
PPO Network Provider Newsletter - Spring 2011
OneHealthPort
Offers Statewide
Credentialing
Service
Group Name and Number
required on all FCH PPO claims
First Choice Health PPO Network is a Preferred Provider
Organization (PPO) and not an insurance company. We
do not have patient eligibility information; therefore, we
are not able to verify patient eligibility information when
we receive claims for pricing.
We rely on providers to submit patient group information on claims
so that we can accurately price the claim and submit it to the
appropriate payor for claims adjudication and payment. Failure to
provide patient group information will cause the claim to be returned
to the provider, as First Choice Health PPO Network (FCH PPO) will
not have the necessary information to forward on the claim to the
appropriate payor for adjudication and payment processing. For Professional claims, this information should be submitted as follows:
• The Employer Group Number in field 11 on the CMS 1500
• Employer Name in field 11b
• Payor Name in field 11c
For Institutional claims:
• The Employer Group Number in field 52 on the UB-04 claim form
• Employer Name in field 51
• Payor Name in field 50
Patient group information can also be found on our website at www.fchn.com under the Payor & Employer Group search function. For more information, contact Provider Relations at (800) 231-6935 Ext. 2103 or via email at [email protected].
(800) 231-6935
ProviderSource, an online system for
centralized collection, verification
and distribution of all provider data for
credentialing and privileging went live
November 3rd, 2010. To use ProviderSource, each
credentialed provider or practitioner
must be set up with his or her own
unique OneHealthPort login. Organizations can set up credentialing staff and practitioners
with OneHealthPort accounts to
prepare for the new service.
More information is available on the OneHealthPort website (www.onehealthport.com). 3
PPO Network Provider Newsletter - Spring 2011
Payor Update
2011 Holiday
Schedule
New Payors:
• Boulder Administration Services
and its initial two groups are
effective January 1, 2011. Boulder
is also a payor under Beech Street.
• Innovante Benefit Administrators
and its initial two groups are
effective January 1, 2011.
• Nesika Health Group is new
effective January 1, 2011. They are
primarily located in Oregon.
• Spokane County Project Access is
new effective November 1, 2010. They will access Spokane County
providers only.
FIRST CHOICE HEALTH IS CLOSED FOR
THE FOLLOWING HOLIDAYS:
Other Updates:
• Nooksack River Casino has
changed its venue of access
from a direct contract to access
via Shasta Administrative
Services, effective February 1, 2011.
• Southwest Washington
Medical Center has changed
its venue of access from The
Loomis Company to a direct
contract effective January 1,
Charitable Giving Foundation
With many individuals and families struggling in our current economy,
The First Choice Health Charitable Giving Foundation continues to distribute
charitable giving dollars each quarter to food banks and additional organizations
that provide charitable support throughout our communities. We at First Choice
Health look forward to a brighter future and are proud to help make it possible.
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The Auburn Food Bank
Ballard Food Bank
Capitol Hill Housing Foundation
Copalis Crossing Food Bank
Food Bank of Alaska
Idaho Foodbank Warehouse
Lynnwood Food Bank
Meals on Wheels - Mid City
Concerns, Inc in Spokane, WA
North Helpline
Oregon Food Bank
Pacific Beach Food Bank
Prospect Enrichment Preschool
Access to our Customer Service and
Provider Relations voicemail systems
will be available the days we are closed. We will respond to all messages within
24 hours of re-opening.
If you have any questions regarding
the holiday schedule, please contact
Provider Relations at (800) 231-6935
Ext. 2103. 2011.
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• Memorial Day
Monday May 30th, 2011
• Independence Day
Monday July 4th, 2011
• Labor Day
Monday September 5th, 2011
• Second Harvest Food Bank in
Spokane, WA
• Volunteers of America of E. WA & N. ID
• Women’s & Children’s Free
Restaurant
• Vanessa Behan Crisis Nursery
• Washington Health Foundation
• Alliance for Education
• American Heart Association
• National MS Society
• Childhaven
(800) 231-6935
“State of the
Network” Reporting
AK
WA
MT
OR
ID
In an ongoing effort to maximize value to
our PPO Network, First Choice Health
PPO Network (FCH PPO) is always
working to recruit new providers, target
expansion areas and fill any gaps that
may exist within our network service area. We are pleased to announce that as of
March, 2011 our network includes 55,949
practitioners, 254 hospitals, and 1,874
ancillary facilities.