Resources

First Choice VIP Care Plus (Medicare-Medicaid Plan) values excellent relationships with our health care providers. Together, we can work to improve the quality of and access to care for our members.

Use this section of our site to access the resources you need most, including:

Claims and billing

Claim submission/payment information:

• Electronic Claims Submission Opens a new window
  Payer ID: 77009
• Paper Claims Submission:

First Choice VIP Care Plus
Claims Processing Department
P.O. Box 7106
London, KY 40742-7106

• Direct entry claims submission through Change Healthcare Opens a new window
• Electronic Funds Transfer/Electronic Remittance Advice Enrollment Opens a new window

Other claim information:

• Appropriate usage of claims modifiers 25 and 59 (PDF) Opens a new window
• CES Explanation Codes (PDF) Opens a new window
• Claim dispute form (PDF) Opens a new window
• Common errors on claims submissions (PDF) Opens a new window
• Waiver of liability form for non-participating provider appeals (PDF) Opens a new window

Contacts

• Provider Network Management Account Executive map (PDF) Opens a new window
• Provider Network Behavioral Health Account Executive map (PDF) Opens a new window
• Provider Network Management Account Executives (PDF) Opens a new window
• Call Provider Services at 1-888-978-0862 or you can contact us by using our secure form

Credentialing

• Credentialing

Prior authorization

• Prior authorization
• Prior authorization lookup tool

Provider manual

• Provider manual (PDF) Opens a new window
• Home and community-based services provider manual (HCBS) section (PDF) Opens a new window

Quality

• Adult Body Mass Index (BMI) Assessment Claims Coding Chart (PDF) Opens a new window
• Care for the Older Adults (COA) Claims Coding Chart (PDF) Opens a new window
• Care for Older Adults (COA) Form (PDF) Opens a new window
• Clinical Resources
• Consumer Assessment of Healthcare Providers and Systems (CAHPS®) and Health Outcomes Survey (HOS) Information (PDF) Opens a new window
• Controlling Blood Pressure Claims Coding Chart (PDF) Opens a new window
• Diabetes Coding for HEDIS (PDF) Opens a new window
• HEDIS Incentive Program (PDF) Opens a new window
• Medicare Risk Adjustment Overview and Documentation Guidance (PDF) Opens a new window
• Promoting Physical Activity Notice (PDF) Opens a new window
• Quality Assessment and Performance Improvement
• Transitional Care Management With Medication Reconciliation Post-Discharge Notice (PDF) Opens a new window
• Urinary Incontinence Notice (PDF) Opens a new window

Training and Education

First Choice VIP Care Plus (Medicare-Medicaid Plan) provides training and education resources tailored to the needs of our new Medicare and Healthy Connections Medicaid providers. Our goal is to offer a variety of learning opportunities that help participating providers deliver high quality, cost-effective care to our members.

Our current learning opportunities include:

• Cultural Competency
• Model of Care
• Training Modules
• Resources for Integrated Care — Resources for dual eligibles
• Fraud Waste and Abuse

Working with First Choice VIP Care Plus

• Grievances
• Integrated care management
• Provider Reference Guide (PDF) Opens a new window
• Service area map (PDF) Opens a new window
• South Carolina Healthy Connections Prime
• Reimbursement Policies

Check back often, since we'll update this section with important provider information. If you need help or have questions, please call Provider Services at 1-888-978-0862.

If you aren't yet a participating provider and would like information about joining our network, call 1-888-978-0862.

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