If you need to report a group addition, change, or termination from our network, complete the Group Information Form (referred to as 'Exhibit E' in the Contract Holder Agreement).
If you have any questions about how to complete the form, email [email protected] or call (800) 231-6935 and ask to speak with your assigned Account Manager.
The Agency for Healthcare Research and Quality's (AHRQ) is the lead Federal agency charged with improving the safety and quality of America's health care system. AHRQ develops the knowledge, tools, and data needed to improve the health care system and help Americans, health care professionals, and policymakers make informed health decisions. AHRQ works within the U.S. Department of Health and Human Services (HHS) and with other partners to make sure that the evidence is understood and used in an effort to achieve the goals of better care, smarter spending of health care dollars, and healthier people..
We offer several short videos dedicated to health plan education and support. Visit our YouTube channel to access all First Choice Health videos.
Looking for provider videos? Visit our Provider Webinars page.
AMA Physicians provides you with basic professional information on virtually every licensed physician in the United States. AMA member physicians are offered an expanded listing that contains additional information such as office hours, accepted insurance providers, educational history, and other helpful information.
First Choice Health provides a directory listing Behavioral Health facilities throughout the United States which are considered in our Provider Network. If you or a family member are looking for a facility to treat Substance Use or Mental Health issues, we recommend that you consider one of the locations listed in this directory.
Click here to view the most recent Behavioral Health Directory.
The Centers for Disease Control is one of the major operating components of the Department of Health and Human Services (HHS). CDC works 24/7 to protect America from health, safety and security threats, both foreign and in the U.S. Whether diseases start at home or abroad, are chronic or acute, curable or preventable, human error or deliberate attack, CDC fights disease and supports communities and citizens to do the same. CDC increases the health security of our nation. As the nation's health protection agency, CDC saves lives and protects people from health threats. To accomplish our mission, CDC conducts critical science and provides health information that protects our nation against expensive and dangerous health threats, and responds when these arise.amp;#39;s health.
First Choice Health has partnered with the Consumer Reports Choosing Wisely campaign, which provides tools and resources to help you talk about your care options with yourdoctor(s) to ensure you receive care that's right for you.
First Choice Health does not automatically renew fee schedules on an annual basis. We will advise our contracted providers when a new fee schedule becomes effective. If you would like a copy of your existing fee schedule, please email [email protected].
First Choice Health Medical Management offers providers a variety of tools and resources to assist with patient care. Contact our Intake Coordinators by phone (800) 808-0450 or by fax (888) 272-3289
Healthfinder has resources on a wide range of health topics selected from approximately 1,400 government and non-profit organizations to bring you the best, most reliable health information on the Internet.
Sign in to view the following:
- Authorization for Release of Information
- Designation of Authorized Representative
- Cancellation of Authorized Representative
- Medical Claim Form
- Vision Services Claim Form
- Accident/Injury Questionnaire
- Subrogation Agreement
- Authorization for Release of Information
- Coordination of Benefits
- Walgreens MOD Form
- MedImpact Pharmacy Direct Member Reimbursement Form
- Healthcare Terminology
- Reading your Explanation of Benefits (EOB)
KidsHealth is the most-visited site on the Web for information about health, behavior, and development from before birth through the teen years. Created by The Nemours Foundation's Center for Children's Health Media, the award-winning KidsHealth provides families with reliable, accurate, up-to-date, and jargon-free health information they can use. KidsHealth has separate areas for kids, teens, and parents each with its own design, age-appropriate content, and tone. There are thousands of in-depth features, articles, animations, games, and resources-all original and all developed by experts in the health of children and teens.
Medical policies are used by our Medical Management clinical staff to ensure decisions are made in an unbiased and consistent manner that best serves the interests of First Choice Health participants. Medical policies are not intended to offer medical advice or replace medical judgment.
MedlinePlus is the National Institutes of Health's Web site for patients and their families and friends. Produced by the National Library of Medicine, the world's largest medical library, it brings you information about diseases, conditions, and wellness issues in language you can understand. MedlinePlus offers reliable, up-to-date health information, anytime, anywhere, for free. You can use MedlinePlus to learn about the latest treatments, look up information on a drug or supplement, find out the meanings of words, or view medical videos or illustrations. You can also get links to the latest medical research on your topic or find out about clinical trials on a disease or condition.
The National Cancer Institute coordinates the National Cancer Program, which conducts and supports research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer, rehabilitation from cancer, and the continuing care of cancer patients and the families of cancer patients. Specifically, the Institute:
- Provides research grants and cooperative agreements to coordinate and support research projects conducted by universities, hospitals, research foundations, and businesses throughout this country and abroad.
- Conducts research in its own laboratories and clinics.
- Supports education and training in fundamental sciences and clinical disciplines for participation in basic and clinical research programs and treatment programs relating to cancer through career awards, training grants, and fellowships.
- Supports research projects in cancer control.
- Supports a national network of cancer centers.
- Collaborates with voluntary organizations and other national and foreign institutions engaged in cancer research and training activities.
- Encourages and coordinates cancer research by industrial concerns where such concerns evidence a particular capability for programmatic research.
- Collects and disseminates information on cancer detection, diagnosis, treatment, prevention, control, palliative care, and survivorship.
- Supports construction of laboratories, clinics, and related facilities necessary for cancer research through the award of construction grants.
- Support the Frederick National Laboratory for Cancer Research - the only federally funded research and development center dedicated exclusively to biomedical research.
The National Institutes of Health (NIH), a part of the U.S. Department of Health and Human Services, is the nation's medical research agency-making important discoveries that improve health and save lives. NIH's mission is to seek fundamental knowledge about the nature and behavior of living systems and the application of that knowledge to enhance health, lengthen life, and reduce illness and disability. In pursuing this mission, NIH improves health by promoting treatment and prevention, contributes to society by driving economic growth and productivity, and expands the biomedical knowledge base by funding cutting-edge research and cultivating the biomedical workforce of today and tomorrow. amp;lt;/p>
The Nebraska Health Network waiver request is an opportunity for providers participating in the Nebraska Health Network to submit a request for enrolled members to see an Out of Network provider at In-Network Tier 2 pricing. The requesting provider must complete and sign the form below. Instructions on where to submit the completed form can be found on the form itself. Once a decision is made, both the member and provider will be notified by letter of the outcome.
For questions, contact First Choice Health at 1-800-517-4078 or [email protected]
We encourage First Choice Health members to take advantage of Preventive Care Services. Routine checkups and screenings can help you avoid serious health problems, allowing you and your doctor to work as a team to manage your overall health, and help you reach your personal health and wellness goals.
The First Choice Health Provider Manual provides the basic information you and your office staff need when seeing FCH PPO patients as well as direction and clarification regarding your obligations as a FCH PPO provider.
Quarterly 'Standard' GeoAccess reports illustrate the breadth of our network in the following states: Alaska, Colorado, Idaho, Montana, North Dakota, South Dakota, Oregon, Washington and Wyoming. These reports display the number of a given provider type/group (e.g., PCPs, specialists, pediatricians, etc.) within a specific zip code, city, or county. Submit a request for customized GeoAccess reports.
The Substance Abuse and Mental Health Services Administration (SAMHSA) has established a clear vision for its work-a life in the community for everyone. To realize this vision, the Agency has sharply focused its mission on building resilience and facilitating recovery for people with or at risk for mental or substance use disorders. SAMHSA is gearing all of its resources-programs, policies, and grants toward that outcome.
To access the tools and resources you are required to Sign In to First Choice Health.
- Claim Status Inquiry
- Claim Activity Report
- GeoAccess Reports
- State of the Network
- Provider Credentialing Status
- Payor Bulletins
- Repricing Instructions
- Remote Access Guidelines
- Monthly Provider Files
- Timely Audit Process Files
- Mid-Month Provider Files
- OIC Report
Terming an existing practice address: Send an email to PPOFileMain[email protected] indicating you wish termination of a specific practice address. Include your NPI and Tax Identification numbers so we can find you in our system.
Changing/adding a billing address: A billing address equals pay to address or where the checks need to be sent. It should match what is being sent in box 33 on the CMS 1500 or EDI form locator 2010AA (street address) or 2010AB (PO Box). To update this address type, send an email to [email protected] indicating you wish to change your billing address. Include your NPI and Tax Identification numbers so we can find you in our system.
Tax Identifier Number changes:
- If you are joining an existing TIN that is contracted with FCH, your new Tax ID (TIN) information must be reflected on your online application. Update the application and attest and we will update your demographic information.
- if you are adding a brand new TIN to FCH, add it to your application and attest. Then, email a W9 to [email protected] along with messaging indicating that you have added a new TIN.
- If you are terming an existing TIN, please email [email protected] with the effective date of the termination.
All other changes not listed above (new practice address, name change, specialty change, etc): Ensure your demographics are correct and accurate on either the ProviderSource application (WA state) or CAQH application (outside WA state). Once all your information has been updated and attested to, we will automatically get the updates and make the change in our system within 2 business days.
Access tutorials and webinars designed to help providers and office staff navigate our website and utilize the tools offered to them.
We offer short tutorials to assist users with the following tools:
- Benefits and Eligibility
- Claim Status
- Priced Claim Status
- Payor/Employer Group Search
- FCHA Benefits and Eligibility
- FCHA Claim Status Inquiry
We also offer an in-depth webinar that covers topics such as:
- PPO Network Business Model
- How to look up a payor/employer group by name or number
- How to obtain claim status
- How to obtain Benefits and Eligibility
- Payor web links
- When to call Provider Relations for assistance
- ID card samples
These tutorials and webinar are helpful for all providers and office staff.
FCH Providers who have opted in for Weekly Claims Activity Reports can view the reports.
Reports are run every Monday and summarize all claims priced by FCH for your billing office (determined by Tax Identification Number).
Reports include the following information:
- How the claim was received for pricing (batch type)
- When the claim was received and completed
- The FCH allowed amount
- Disposition of the claim (forwarded on for processing or returned for errors)
- Error codes associated with the claim
- Note that the error description line will indicate the charge line that is associated with that specific error.
Providers who have opted to receive this report will not receive any FCH paper pricing worksheets. The report is to be reviewed weekly and if any errors are identified, all associated claims should be corrected and resent to FCH for pricing.