Resources

Opioid information from the Centers for Disease Control and Prevention (CDC)

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
  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
• Electronic Funds Transfer/Electronic Remittance Advice Enrollment

Other claim information:

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

Contacts

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

Credentialing

• Credentialing
• Patient-centered medical home (PCMH)

Prior authorization

• Prior authorization
• Prior authorization lookup tool

Provider manual

• Provider manual (PDF)
• Home and community-based services provider manual (HCBS) section (PDF)

Quality

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

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)
• Service area map (PDF)
• 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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