Providers

Change Healthcare System Interruption

Change Healthcare, our electronic data interchange (EDI) clearinghouse for claims and payment cycle management, continues to address their network interruption related to a security incident. Below are updates for our systems and processes:

  • Claims payments: We have resumed payments for claims submitted prior to the incident. Since Change Healthcare is still unable to accept claims submissions, providers who submitted claims during the outage may be able to resubmit them either through additional solutions identified below through Availity and PCH Global, or once Change Healthcare’s connectivity is restored, through Change Healthcare. We appreciate the inconvenience this is causing.

IMPORTANT UPDATE: First Choice VIP Care Plus acknowledges many providers were unable to submit claims as a result of the service disruption. Therefore, we are extending the claims timely filing deadline for claims that would have been rejected due to untimely filing. For more details, see the recent Claims Timely Filing Deadline Extension provider notice.

  • Electronic claims submission: We have established a connection with Availity to receive electronic claims. If you or your clearinghouse do not currently use Availity to submit claims, you may register at: https://www.availity.com/Essentials-Portal-Registration. You will find registration options for Healthcare and Atypical Provider, so please choose the one that aligns with your business. For registration process assistance and other resources, access the training site link on the Availity registration page.

IMPORTANT UPDATE: In order to submit electronic claims to First Choice VIP Care Plus you must register with Availity. For additional information and resources see the recent  Additional Information for Availity provider notice.

  • Manual claims submission: We have established a direct claims entry process through PCH Global. To submit claims directly, please go to https://pchhealth.global and click the Sign-Up link in the upper right-hand corner to register. Complete the registration process and log into your account. You will be asked how you heard about PCH Global; select Payer, then AmeriHealth. Access your profile by clicking on Manage User and then My Profile. You will need to complete all the profile information. When you go to the Subscription Details screen, select the More option on the right-hand side to see how to enter the promo code Exela-EDI.
  • When you are ready to submit claims, use the following information to search for our payer information:

    1. Payer name: First Choice VIP Care Plus
    2. PO Box: 7106

    For a detailed walk through of the registration process, refer to the PCH Global Registration manual, found on the PCH Global website in the Resource Menu.

  • Electronic remittance advice: Electronic remittance are available at this time. However, some individual remittance advices may not be available due to Change Healthcare’s service disruption related to the security incident.

IMPORTANT UPDATE: First Choice VIP Care Plus has established an alternative option for our providers to access the electronic remittance advice (ERA/835) file through ECHO Health. For additional information, please see the recent 835 Access provider notice.

  • Prior authorization submission and processing: The prior authorization systems continue to operate normally.
  • Eligibility verification, claim status inquiry, and authorization inquiry: These capabilities continue to be available via NaviNet. If you do not have access to NaviNet provider portal, please visit https://register.navinet.net/ to sign up.

This interruption continues to have downstream impacts to our plan and the provider community, including:

  • Our ability to:
    • Remit claim payments and remittance advice, both electronic and paper
  • Providers' ability to:
    • Submit claims directly to Change Healthcare via NaviNet and ConnectCenter
    • Access and view electronic remittance advice in NaviNet

Please note, in the interim our Provider Services Department will not be able to assist with the processing of your payments or obtaining your 835 files any sooner. If you have other questions, you may contact Provider Services at 1-888-978-0862.

We thank you for your partnership and will continue to provide updates as we work to resolve the downstream impacts of Change Healthcare's service interruption

First Choice VIP Care Plus is a Healthy Connections Prime Medicare-Medicaid Plan offered by Select Health of South Carolina. South Carolina is one of several states selected to design new approaches to coordinated care for people on both Medicare and Medicaid.

As a First Choice VIP Care Plus Medicare-Medicaid Plan provider, you are a part of a dedicated network that is ready to meet our members' health care needs. As partners in care, we'll work with you to ensure that our members receive access to the quality health care they need and deserve, achieving the goals of this plan which are to:

  • Improve health outcomes
  • Delay the need for nursing facility care
  • Reduce avoidable emergency department visits and hospital readmissions
  • Increase access to home and community-based services

Our robust network is designed to provide our members with integrated care. You will find other committed providers like you in the directories below.

Provider data contained within the online directory is updated daily Monday through Friday.

If you notice any errors in the directory, please fax, on practice letterhead, the information as it should appear to the attention of Provider Services at 1-855-327-4980.

Want to join our network?

We're always looking for providers to join our network of care. Learn about joining our provider network today. Check out credentialing information for First Choice VIP Care Plus.

Other quick resources

Please refer to the other provider links for additional information and resources. Check back often, as we continue to add and update provider materials, resources, trainings and communications.

Have questions?

Call Provider Services at 1-888-978-0862 (TTY/TDD 711), 8 a.m. to 8 p.m., 7 days a week.

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