Frequently Asked Questions

Find frequently asked questions below

• CLAIMS PROCESSING AND APPEALS

  Medical and Pharmacy Claims

  HCH prices medical claims for several self-funded employer groups. Please refer to the member's ID card for the group's specific claims mailing address.

  Provider Claims Processing

  If you have questions about a claim or need help with claim processing, call our
  Customer Experience Team: (866) 945-2292. It's the quickest way to have claims questions answered.

  The Customer Experience Team member may transfer your question to an associate who can answer your question. Claims may take up to five business days to process. 

  Disputing Your Claim

  If a claim is not resolved to your satisfaction, please contact the customer service phone number listed on the member’s ID card. For pricing/allowable disputes you may contact us through our Customer Experience Team at (888) 806-3400 to file your inquiry. You have 180 days from the date you received the explanation of payment to submit a formal appeal in writing and send it to the claims mailing address listed on the members’ ID card. We’ll review and respond to you within 30 business days.

• CREDENTIALING

  What is credentialing?

  The credentialing process includes relevant training, licensing, registration, certification, and academic background. Credentialing is done before a healthcare provider joins Healthcare Highways and is separate from the contracting process.

  Once a practitioner, group and/or facility information has been checked and verified, the designated Chief Medical Officer and the Medical Staff Credentials Committee review and approve a clean practitioner, practitioner group and/or facility’s file and then they can join our team of providers.

  Credentialing offers numerous benefits including patient safety. Ensuring only qualified professionals can provide care, reducing potential medical errors. Credibility bolsters the reputation and trustworthiness of credentialed healthcare professionals and organizations.

• PROVIDER-RELATED

  How often is the healthcare service provider search/locator updated?

  It's updated daily.

  How do I update my health provider information?

  Click here to update your health provider information. Click the link to download an Excel spreadsheet with instructions to update your provider information. 

• MEMBER-RELATED

  We’re always happy to help with any questions that you may have. Don’t see the answer to your question below? Our Customer Experience Team is here to provide extra support Monday-Friday, 8 a.m. - 5 p.m., Central Time: (866) 945-2292.

   

  Health Plan

  Do I need to get approval in advance for some services?

  Pre-certification is required on certain services or healthcare facilities depending on your plan. Notification of in-patient hospitalization is required prior to admission or within 48-hours of an emergency admission. Certain outpatient procedures may also require pre-certification. If you have questions or need help with pre-certification, please contact our Customer Experience Team at (866) 945-2292.

   

  Setting Up a New Account

  How do I access my online member portal?

  If the group number on your ID card begins with the letters HCH, then you can easily access the online member portal.

  How do I add or delete family members?

  Please reach out to your employer’s Human Resources department to add or delete a family member as a covered dependent.

   

  Healthcare Highways ID Cards Eligibility

  Am I covered? What about my dependents?

  You can find an explanation of who is covered under your plan and what benefits are available by logging into your member portal.

  How do I order a new ID card?

  You can request a new member ID card by logging into your member portal or by calling our Customer Experience Team at (866) 945-2292.

   

  Benefits

  How do I find a benefit summary?

  Please look at the resources section within your member portal to view your Summaries of Benefits and Coverage.

  Still have more questions about your benefits?

  For benefit plan questions, please call (866) 945-2292. You may also access your plan benefits through your HCH member portal.

   

  Telemedicine

  How do I sign up for Telemedicine?

  Your health plan may include telehealth services like MDLive. Look on your member ID card to verify coverage. If you do have this valuable service that allows you to have consultations with healthcare professionals using your phone, tablet, or computer, then we recommend setting up your account now so that you won’t spend extra time registering when the need for care arises. For members covered by MDLive, there are three quick, convenient ways to register. Text DOCTOR to MDLIVE (635483). Go online to mdlive.com/hch. Call MDLIVE at (888) 974-0843.

   

  Providers

  Did you not have a good experience with a Healthcare Highways provider?

  Your member rights matter. You can file a grievance about the quality of care you received from a participating in-network provider by contacting us in writing at: Healthcare Highways Hall Park 3001 Dallas Pkwy., Ste. 700 Frisco, TX 75034 Attn: Corporate Quality Management

   

  Member Rights and Protections

  Where can I find information about my rights and protections as a member? 

  You can find detailed information about your rights and protections by clicking on the "Member Rights and Protections" legal statement available here. We encourage all members to review this document to stay informed about the policies and support available. If you have further questions or need assistance, please contact our support team at (866) 945-2292.

• 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 us at (866) 945-2292.