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Let’s Get Started!

The Wellness Division of. H . E . L . P . Health Education and Lifestyle Planning. Let’s Get Started!. Let’s Get Started! What is H.E.L.P. ?. This program is designed to help our members identify their health risks and take steps to improve their health. What are the

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Let’s Get Started!

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  1. The Wellness Division of H.E.L.P. Health Education and Lifestyle Planning Let’s Get Started!

  2. Let’s Get Started! What is H.E.L.P.? This program is designed to help our members identify their health risks and take steps to improve their health.

  3. What are the • Program Requirements? • Eligible HealthChoice members must: • Complete their free comprehensive preventive services visit • Complete their free comprehensive metabolic and lipid panels • Complete their health risk assessment

  4. What are the Program Requirements for Providers? • 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

  5. Preventive Medicine Codes Paid at 100% 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)

  6. Preventive Medicine Codes Paid at 100% of Allowed Charges • Established Patient – Comprehensive Preventive Medicine Exam • 99395 – patient age 18-39 • 99396 – patient age 40-64 • 99397 – patient age 65+ (non-Medicare)

  7. Metabolic and Lipid Panel Codes Paid at 100% of Allowed Charges • Metabolic Panel • 80053 – comprehensive metabolic panel • or • 80050 – general health panel • Lipid Panel • 80061 – comprehensive lipid panel

  8. Did You Know? • When you use the CPT Codes designated for theH.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.

  9. Other Services Provided During the Office Visit? 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.

  10. Information Requested From the Preventive Exam • 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

  11. What You Might See

  12. Watch for • These Instructions • H.E.L.P.Provider Instructions on the HealthChoice Website at www.healthchoiceok.com

  13. 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. Preventive Services Covered at 100% of Allowed Charges.

  14. Questions? 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.

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