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, calling Service Operations – 888-806-3400, is the quickest way to have your claims questions answered.
The Service Operations team member may escalate your question to this team to answer your question. A reply may take up to (5) business days.
Please use the written Provider Claims Inquiry Process if a claim remains unsolved to your satisfaction. You have 180 days from the date you received the explanation of payment (or per your provider agreement) to write us. We’ll review and respond to you within thirty (30) days.
Please access the Administrative Handbook for futher information about the claims inquiry and appeals process.
How often is the healthcare service provider search/locator updated?
How do I update my health provider information?
Click here to update your health provider information. An excel spreadsheet will download with instructions to help you update your provider information.
What is credentialing?
Credentialing is done before a healthcare provider joins Healthcare Highways and is separate from the contracting process. The credentialing process includes (but not limited to): relevant training, licensure, registration, certification, and academic background.
Who is CerpassRx?
We are the Pharmacy Benefit Manager, formerly known as Healthcare Highways Rx (HCHRx). We assist your employer in keeping your overall drug costs to a minimum and fill your prescriptions. Learn more about us here.
Can my employees/patients still use my retail pharmacy?
Our broad pharmacy network includes all national chains and many local pharmacies. Our customer service area can provide additional participating pharmacies in your area by calling (844) 636-7506.
What number should the pharmacy call if there are issues processing prescriptions?
The pharmacy should call the number on the back of your ID card (844-636-7506).
What Is Prior Authorization?
Some drugs prescribed to your employees 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. Should they decide to obtain the medication without a prior authorization, they will be re-quired to pay the full cost of the medication.
What Is A Prescription Quantity Limit?
Quantity limits are used to ensure medications are being used safely and correctly. These rules may limit the amount of medication a member is able to receive over a certain period of time.
Verify Member Eligibility
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:
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.