Who is First Choice Health PPO
Network (FCHN)?
• Largest independent physician and hospital owned PPO in the Northwest
• Serving just under one million people in Washington, Oregon, Alaska, Idaho, Montana, North Dakota, South Dakota and Wyoming
• Competitive PPO pricing network of multi-specialty providers and facilities (FCHN)
• Third Party Administration (TPA - FCHA) • Medical Management
• First Choice Health Employee Assistance Program
First Choice Health Clients
• PPO Network includes hospitals, physicians, urgent care centers, laboratories, radiology centers, home
healthcare, chiropractors, alternative care providers and more
• Health Plans
• Unions and Trusts
Why does FCH Require Group
Information?
FCHN will forward your priced claims to the payor based on the group name or number you submit on your claim.
How to Locate Group Number or
Name
• ID cards include: – Group number – Group name – Payor – FCHN logo • FCHN Website: www.fchn.com/ppo/providers/payorsearch/PayorSearch.aspxRequired Information For Submitting
Claims to FCH
Submit all claims electronically and when doing so, please include the following:
Employer group number (whenever possible, use group number v. group name to ensure the
correct payor is selected when forwarding the priced claim)
• Field 11 on the CMS 1500 form • Field 62 on the UB04 form
• Loop 2000B (subscriber information), segment SBR03 (policy or group number) for electronic claims
or
Employer group name:
• Field 11b on the CMS 1500 form • Field 61 on the UB04 form
• Loop 2000B (subscriber information), segment SBR04 (subscriber group information) for electronic claims
and
Payor name (do not use First Choice Health Network)
• Field 11c on the CMS 1500 form • Field 50 on the UB04 form
• Loop 2010BB (payor name), segment NM103 for electronic claims
Required Information
CMS 1500 Form UB04 EDI
Group Number Field 11 Field 62 Loop 2000B, Segment SBR03 Employer Name Field 11b Field 61 Loop 2000B, Segment SBR04
Submitting Claims Electronically to
FCH for Pricing
• For providers submitting claims to First Choice Health PPO Network on paper, we suggest options that can assist you in converting to electronic billing. Electronic transactions are a very efficient way to submit claims to FCH and by sending your claims electronically you
speed up your revenue cycle!
• Below are some alternative ways to send your claims electronically to us at low or no cost to you:
– Office Ally: www.officeally.com
– MD On-line: www.mdon-line.com/mdonline/index.asp
EDI 5010 Transactions
• 5010 transactions requires healthcare providers to use only a street address as the billing provider address. • Billing street address is not your “Pay-to” address. • Updates can be faxed to 206-268-2940 or emailed to
PPOFileMaintenance@fchn.com, Attn: Provider Information Management.
• You can also send billing updates on our Provider
Information Change Form or submit your changes using
FCH PPO Network
• At FCH we price claims to your contracted rates and forward to the payors to apply benefits.
• FCH PPO Network does not have access to patient eligibility and we do not pay claims.
• The member’s ID card should include the group number, group name and payor name.
A Payor is a contact holder, insurer, or third party
administrator with FCH PPO that sponsors employer groups’ access to our network of providers.
List of Payors
Column 1: Name of entity processing claims (w/the exception of Beech Street) Column 2: Customer Service # for claims status, eligibility, etc. Column 3 & 4: Claims
Submission Address
(Professional and Institutional) Column 5:
Preauthorization/Precertification contact information
CHPW Card
Example: Community HealthEssentials
Group Name Payor/Claims Submission Address Policy ID Number (SS#)
CHPW will be participating in the Washington State Health Benefit Exchange in 2014. First Choice Health (FCH) will serve as the Preferred Provider Organization (PPO) and First Choice Health Administrators (FCHA) will facilitate administrative services. Services include Customer Service, Utilization Management, Case
Management and Claim Benefits Administration.
Community Health Plan of
Washington (CHPW)
Third Party Administrator (TPA)
A third party administrator is a claims payor who
assumes responsibility for administering health plan benefits.
Third Party Administrator (TPA) Card
Example: First Choice Health Administrators
Group Number Group Name
Payor
Trust Card
Example: Puget Sound Electrical Workers Health & Welfare Trust
Group Name
Group Number Logo Payor
Online Tools and Website Tour
www.fchn.com
• Payor / Employer Group Search
– Including how to view List of Payors
• Priced Claims Status (requires OneHealthPort registration)
• Publications:
– Provider Bulletins – Newsletters
– Subscribe to receive publications via email
• WebSite: If payor has a site where providers can obtain claims status and/or benefits and eligibility, the link can be found here
• Contacts: Information regarding how to contact each payor for claims status or benefits and eligibility • Claims Submission: Claims submission address as well as electronic claims submitter ID number • Client Information: Group number will be located here as well as any service area definitions or
• Allegiance Benefit Plan • Assurant Health
• AW Rehn & Associates • Capitol Administrators • Carpenters Trust
• Christian Brothers
• Coastal Administrative Services
• Employee Benefit Management Services (EBMS)
• First Choice Health Administrators (FCHA) • Government Employees Health
Association (GEHA)
• Health Net (HNOR) • Healthcomp
• KPS Health Plans • MultiPlan
• Providence Health Plan (PHP) • Shasta Administrative
• UMR
• Washington State Health Insurance Pool (WSHIP) • Zenith Administrators
Payors with Web Links
We have several website links for PPO payors to assist providers (below are the top payors with website links).
By selecting First Choice Health as a Health Plan site on OneHealthPort, you will have access to:
• First Choice Health Network secured Provider tools (List of Payors and priced claims status)
• First Choice Health Administrators (TPA) secured Provider tools (eligibility, benefits & claims status)
• FCHA is a Payor within the FCHN PPO network, therefore their tools will provide information the FCHN tools cannot provide.
2013 2013
To view additional claim detail information, please click on the appropriate FCHN Claim ID number.
First Choice Health PPO Network
Provider Relations Department
Provider Relations team functions:
Focus on helping providers understand the PPO Network business model Help contracted providers decrease pricing turnaround times
Conduct provider training visits
Provider Relations Department
Washington/Alaska/Idaho Offices
• Bob Hinman - VP Network Management
• Kendra Freire - Director of Provider Relations Provider Service Representatives:
• Kathryn DeBoer • Charles Dixon
Provider Relations Representatives: • Debi Pierce • Lynn Poelstra • Kimberly Rowland • Marlyce Wright-Alvidrez Phone: 800-231-6935 Ext. 2103 Email: ProviderRelations@fchn.com
Provider Relations Department
Oregon Office
Sharon Thompson – Director, Administrative Services Phone: 503-597-4153
Fax: 503-652-8087
Email: sthompson@fchn.com
Montana Office
Melody Heide - Administrative Services Phone: 406-256-6556
Fax: 406-256-9466