Patient and Customer Transactions

ChoiceCare Network strives to make it easy for provider offices to serve health plan members. Following is general information about ChoiceCare Network policies for utilization management, eligibility, claims submission, and patient referrals.

Utilization Management

ChoiceCare Network does not administer a utilization management program. However, as a ChoiceCare Network provider, you’re asked to follow the protocols of our customers' utilization management programs. As these programs can vary, we recommend you call the phone number listed on the back of your patients' ID cards to obtain additional information about a specific health plan's utilization management program.

Member Eligibility and Claims Submission

The following organizations currently have health plan members with access to ChoiceCare Network: Representative Clients Please refer to back of member ID card to obtain specific information for determining member eligibility and claims submission.

Patient Referrals

ChoiceCare Network is a preferred provider organization. As such, plan members who go to in-network providers receive higher “in-network” benefit levels than they would by seeking medical services from out-of-network providers.

We ask that you refer these plan members to ChoiceCare Network providers to minimize their out-of-pocket expenses. You can find other in-network providers by using ChoiceCare Physician Finder Plus

Provider Information Guide

Key administrative information for ChoiceCare Network.

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Provider Manuals

Information about ChoiceCare Network policies and prodecures, claims, and guidelines.