HealthbyChoice plans
There are four HealthbyChoiceSM (HbC) plans. They are always paired with a Priority Health HMO, POS or PPO medical plan.
- Each HbC plan has a different qualification form. The online tool allows PCPs to select the right online HbC form.
- Members of a HealthbyChoice plan can see any physician, though we encourage HMO and POS plan members to see their PCP.
- A full physical is not required to complete the form.
See a chart comparing the plan designs.
See more details in the HealthbyChoice FAQs page.
Provider reimbursement
Usually a member must schedule an office visit to enable you to complete a HealthbyChoice qualification form. However, if the member was examined in the 6 months before the date you submit the form and the required information is on file, you may complete and submit the form without a visit.
Online HbC qualification form, $30 reimbursement
Faxed HbC qualification form, $0 reimbursement
You may complete a paper form that your patient brings to you, or complete the PDF online, print and fax it to us at the number on the form:
Resubmitted online form, $10 reimbursement
- Paid when you update and resubmit a qualification form for a patient who did not initially meet all criteria and who now does meet all the health criteria.
- Applies to HealthbyChoice Progressions and HealthbyChoice Achievements plans.
How to bill
- Bill for the service you perform. This may be a routine visit, follow-up care, a nurse-only visit, a physical or even an allergy injection.
- Collect a copay if a copay is applicable for services you render during the visit.
- Do not collect a copay if the member simply drops off a form for your office to complete, or the visit is for preventive services only.
- For cotinine testing, bill 83887 - Nicotine for quantitative results and 80101 and G0431 for qualitative results.
- For cholesterol screenings, the suggested CPT billing code is 82465.
- For blood sugar screenings for patients without diabetes, the suggested CPT billing codes are 82947 for fasting and 82948 for non-fasting. For patients with diabetes, the suggested code is 83036.
