Who processes Healthcare Highways member's medical and pharmacy claims?
Healthcare Highways processes our members' medical and pharmacy claims.
PROVIDER CLAIMS PROCESSING
If you have questions about a claim or need help with claim processing, call our Service Operations: (888) 806-3400. It's the quickest way to have claims questions answered.
The Service Operations team member may transfer your question to an associate who can answer your question. Claims may take up to five business days to process. If a claim is not resolved to your satisfaction, please contact us through our Provider Claims Injury Process. You have 180 days from the date you received the explanation of payment (or per your provider agreement) to write to us. We’ll review and respond to you within thirty days.
What is credentialing?
The credentialing process includes (but is not limited to): relevant training, licensing, registration, certification, and academic background. Credentialing is done before a healthcare provider joins Healthcare Highways and is separate from the contracting process.
Who is CerpassRx?
CerpassRx is our Pharmacy Benefit Manager, formerly known as Healthcare Highways Rx (HCHRx). CerpassRx helps employers fill prescriptions and keep drug costs to a minimum. Learn more about how CerpassRx can help here.
Can my employees/patients still use my retail pharmacy?
Yes, our network includes all national chains and many local pharmacies. Our customer service area can provide additional participating pharmacies in your area. Just call (844) 636-7506 and we will guide you through the process!
What number should the pharmacy call if there are issues processing prescriptions?
You should call the number on the back of your ID card, (844)-636-7506. They will put the pharmacy in touch with our Customer Service team.
What is prior authorization?
Some prescribed drugs will require special approval or authorization before being filled to ensure they meet the plan’s conditions and requirements for coverage. Prior Authorizations are valid for a specific time-period. Obtaining these medications without first having prior authorizations will require paying the full cost of those medications.
What Is a prescription quantity limit?
Quantity limits are used to ensure medications are being used safely and correctly, and may limit the amount of medications a member can receive over a period of time.
How often is the healthcare service provider search/locator updated?
It's updated weekly.
How do I update my health provider information?
Click here to update your health provider information. Click the link to download an Excel spreadsheet with instructions to update your provider information.
We’re always happy to help with any questions that you may have. Don’t see the answer to your question below? Our Customer Experience Team is here to provide extra support 8 AM to 5 PM, Central Time, Monday through Friday: (844) 869-5640.
Your Health Plan
Do I need to get approval in advance for some services?
Pre-certification is required on certain services or healthcare facilities depending on your plan. Notification of in-patient hospitalization is required prior to admission or within 48-hours of an emergency admission. Certain outpatient procedures may also require pre-certification.
If you have questions or need help with pre-certification, please contact our Customer Experience Team at (888) 869-5640.
Setting up a new account
Can I enroll online into the Healthcare Highways Health Plan?
If the group number on your ID card begins with the letters HCH, then you can easily enroll online through your member portal.
How do I add or delete family members?
Please reach out to your employer’s Human Resources department to add or delete a family member as a covered dependent.
Healthcare Highways ID Cards Eligibility
Am I covered? What about my dependents?
You can find an explanation of who is covered under your plan and what benefits are available by logging into your member portal.
How do I order a new ID card?
You can request a new member ID card by logging into your member portal or by calling our Customer Experience Team at (844) 869-5640.
How do I find a benefit summary?
One way to track your healthcare expenses is through your monthly Explanation of Benefits, or EOB. This statement is easily found on your member portal, and lets you see what medical treatments and/or services were paid for on your behalf.
Still have more questions about your benefits?
For benefit plan questions, please call (888) 869-5640. You may also access your plan benefits through your HCH member portal.
What is a formulary?
A formulary is a list of medications frequently used by members and prescribers to identify and select a safe, effective and affordable treatment option. The formulary for Healthcare Highways Health Plan members is updated twice a year.
What is Step Therapy?
Step therapy is a prior authorization program built to help you save money and stay healthy. This program encourages the use of the most cost-effective and appropriate medications available for treating your condition, before more expensive medications are approved.
Is there a zero copay program?
We recognize the value of remaining compliant to your drug therapy. As a result, select generic medications for certain chronic disease states are available to you at no cost ($0 copay) when covered by our pharmacy benefit manager CerpassRx.
How do I sign up for Telemedicine?
Your health plan may include telehealth services like MDLive. Look on your member ID card to verify coverage. If you do have this valuable service that allows you to have consultations with healthcare professionals using your phone, tablet, or computer, then we recommend setting up your account now so that you won’t spend extra time registering when the need for care arises. For members covered by MDLive, there are three quick, convenient ways to register.
Text DOCTOR to MDLIVE (635483).
Go online to mdlive.com/hch.
Call MDLIVE at (888) 974-0843.
Do I have to use the Healthcare Highways in-network providers for all my healthcare needs?
You always have a choice where to seek care, but coverage depends on your health plan benefits. If your plan does not include an out-of-network benefit, then it is unlikely to cover any expenses related to an out-of-network provider. Even if you do have out-of-network coverage, your out-of-pocket costs will be less if you use in-network providers.
Did you not have a good experience with a Healthcare Highways provider?
Your member rights matter. You can file a grievance about the quality of care you received from a participating in-network provider by contacting us in writing at:
3001 Dallas Pkwy., Ste. 700
Frisco, TX 75034
Attn: Corporate Quality Management
VERIFYING MEMBER ELIGIBILITY
Providers are responsible for verifying member coverage and benefits prior to rendering any non-emergency services or treatments. Providers can confirm a member’s eligibility by accessing the provider portal or calling the number for the health plan in your state:
Group numbers starting with “HH” (in Oklahoma and Texas), call (866) 353-8162.
Group numbers starting with “HH” (in Louisiana), call (866) 547-4255.
Group numbers that start with “HP” (in all states), call (844) 808-1247.