HealthbyChoice plans®

We offer employers two incentive-based HealthbyChoice (HbC) plans:

  • HealthbyChoice Achievements
  • HealthbyChoice Incentives
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 to have their form completed, though we encourage HMO and POS plan members to see their PCP.
  • A full physical is not required to complete the form.
HealthbyChoice plan designs

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

  • Go to the online HbC qualification form and select the correct form for the member's specific plan and effective date. If you are not logged in, you will be asked to log in first.
  • Reimbursement is paid quarterly to the provider or ACN.

Faxed HbC qualification form, $0 reimbursement

You may either 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. Go to the provider forms list.

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 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 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 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.