HealthChoice Care Coordination - Frequently Asked Questions...

How do I qualify for the care coordination program?

Based on claim information and provider input, if you have chronic conditions such as diabetes including pre-diabetes, hypertension, cardiovascular disease, asthma, COPD, hyperlipidemia, or have recently been hospitalized for any related condition, you are eligible to participate in the HealthChoice care coordination program. Once identified, you will receive a phone call from our care coordinator to introduce you to the program, and offer you more information and next steps

What services are included in care coordination?

Your care coordinator will be your advocate in helping you meet your healthcare goals. Working as a team with your providers, your care coordinator will work with your providers and care givers in the development of a treatment plan, utilizing your benefits in the most effective way. Education is primary to compliance with the treatment plan. You will have access to resources and tools along with a web-based library of topics that will help you monitor your condition, your symptoms, and prepare you to discuss matters related to your care with your providers. We want you to take advantage of the preventative services available to you in your area, and to help you make informed decisions, especially during times of transition from one provider to another.

How much does the care coordination program cost?

This program is free to HealthChoice members

When can I contact a care coordinator?

Any time, 24 hours a day. We have medical professionals who will provide answers when you have questions at 1-405-652-1041 or toll free at 1-855-445-1471.

How does this program affect my benefits through HealthChoice?

Your benefits are not impacted at all when participating in the care coordination program. You will receive information on how to better utilize your benefits working with someone to help you navigate the plan. The requirements for pre-certification remain the same as stated in your plan documents.

Am I required to select a primary care physician?

Yes, you are required to select a primary care physician (PCP) who will monitor your care and be a resource to ensure you get the appropriate care at the appropriate time. PCPs can be selected from any participating HealthChoice family practice, general practice, or internal medicine physician. We can also assign a PCP to you if desired and requested.

Can I visit a participating specialist without going through my PCP first?

Yes, but it is always best, if possible, to ensure your PCP is aware of the care you may need so that they can assist in coordinating that care. Your PCP can help direct you to a network specialist which will prevent delays in scheduling and can also prevent duplication of services. This also supports the continuity of your treatment plan and documentation in your medical record.

Who do I call if I have questions regarding eligibility, benefits or claims?

You would contact the HealthChoice medical claims administrators at 1-405-416-1800 or toll free at 1-800-782-5218.

Where do I look for information about in-network providers for HealthChoice?

With access to a computer, you can search for providers at www.healthchoiceok.com, or you can call HealthChoice Customer Service at 1-405-416-1800 or toll free at 1-800-782-5218. Provider information and other plan information is also available through the OMES website at www.sib.ok.gov.

How do I reach the 24/7 Nurse advice line?

In addition to the support you will receive through our care coordinators, ALL members and their dependents participating in a HealthChoice program have access to a 24/7 nurse advice line by calling 1-800-248-7266