PowerPoint Presentation

Lets Get Started!H.E.L.P. Health Education and Lifestyle Planning

The Wellness Division of

Lets 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 Program Requirements?Eligible HealthChoice members must:

Complete their free comprehensive preventive services visitComplete their free comprehensive metabolic and lipid panelsComplete their health risk assessment

What are the Program Requirements for Providers?

Eligible Providers must:

Participate in the HealthChoice Provider NetworkProvide services in an outpatient or medical settingBill the designated CPT Codes for 100% reimbursement of Allowed Charges

Preventive Medicine Codes Paid at 100% of Allowed Charges

New Patient Initial Comprehensive Preventive Medicine Exam

99385 patient age 18-3999386 patient age 40-6499387 patient age 65+ (non-Medicare)

Preventive Medicine Codes Paid at 100% of Allowed Charges

Established Patient Comprehensive Preventive Medicine Exam

99395 patient age 18-3999396 patient age 40-6499397 patient age 65+ (non-Medicare)

Metabolic and Lipid Panel Codes Paid at 100% of Allowed Charges

Metabolic Panel80053 comprehensive metabolic panel or80050 general health panel

Lipid Panel80061 comprehensive lipid panel

Did You Know?

When you use the CPT Codes designated for the H.E.L.P. program, services are covered once per calendar year at 100% of the HealthChoice Allowed Charges, regardless of the patients diagnosis.

There is no copay or other out-of-pocket cost to the HealthChoice member.

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.

Information Requested From the Preventive ExamBiometric ResultsHeight and weightBlood pressure (systolic/diastolic)Resting heart rate (pulse)Lab Results Fasting blood glucoseFasting LDL, HDL, and total cholesterolFasting triglycerides

What You Might See

Watch for These Instructions

H.E.L.P. Provider Instructions on the HealthChoice Website at www.healthchoiceok.com

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.

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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