TotalChoice

Avera Health Plans is excited to launch TotalChoice — a new product for small and large group employer markets in South Dakota and select northwest Iowa counties.

TotalChoice is our newest PPO plan with the broadest network available, including South Dakota's major health systems and many trusted regional providers. TotalChoice plans also include a travel network, using the United Healthcare® Options PPO network for national coverage.

Employers can customize their coverage by freely mixing and matching existing HMO plans alongside the TotalChoice PPO plan options to give their employees maximum freedom and choice of plan types and network options.

Where can I view a provider directory for the TotalChoice plans?

If you are looking for providers WITHIN the Avera Health Plans network service area, map of the states and/or counties below, please visit this link to view participating providers in the TotalChoice network.

Map of TotalChoice counties

South Dakota

All counties

Iowa

Buena Vista, Cherokee, Clay, Dickinson, Emmet, Ida, Lyon, O'Brien, Osceola, Palo Alto, Plymouth, Sioux and Woodbury

Nebraska

Antelope, Boyd, Brown, Cedar, Cherry, Cuming, Dakota, Dixon, Holt, Knox, Keya Paha, Madison, Pierce, Rock, Stanton, Thurston and Wayne

When traveling or residing OUTSIDE the Avera Health Plans network service area (any counties outside of the map above), the TotalChoice plan includes an out-of-area network solution with UnitedHealthcare® (UHC). To view the UHC Provider Directory visit UnitedHealthcare's Provider Directory.

  • Select “Medical Directory” or “Behavioral Health Directory” based on your needs.
  • Select “Employer and Individual Plans” for type of plan.
  • If you selected “Medical Directory” above, scroll down to “Options PPO” when asked “What plan are you looking for?”
  • From here, customize your search for a provider or facility.

Where is the TotalChoice product sold?

The TotalChoice sales area includes all South Dakota counties and 13 northwest Iowa counties:

  • Buena Vista County
  • Cherokee County
  • Clay County
  • Dickinson County
  • Emmet County
  • Ida County
  • Lyon County
  • O’Brien County
  • Osceola County
  • Palo Alto County
  • Plymouth County
  • Sioux County
  • Woodbury County

Map of South Dakota and Iowa counties that offer TotalChoice

Both small and large employers that are based in this sales area are able to purchase the TotalChoice products.

Where should I send claims?

For services rendered inside the TotalChoice service area, send all claims to First Choice Health, at PO Box 2289, Seattle, WA 98111-2289 using Payer ID AH002.

For services rendered outside the TotalChoice service area, send all claims to United Healthcare Options PPO Network, at UHSS, PO Box 30783, Salt Lake City, UT 84130-0783 using Payer ID 39026.

What is the role of First Choice Health and why should I send claims there?

We have contracted with First Choice Health to create our custom TotalChoice network. Because Avera Health Plans has a robust Participating provider network in South Dakota and Iowa, most claims will be passed directly to Avera Health Plans where claims will be adjudicated using the Avera Health Plans’ contracted rates. Providers who are not contracted directly with Avera Health Plans will have claims repriced by First Choice Health network.

What does the ID card look like for members who have the TotalChoice plan?

Members who have purchased the TotalChoice plan will have a distinctive TotalChoice logo on the front of their ID card.

TotalChoice insurance care, front view.
TotalChoice insurance care, back view.

How will I get my remittance advice and EOPs?

Avera Health Plans issues remittance advice and EOBs/EOPs, for services rendered inside the TotalChoice service area. United Healthcare issues remittance advice and EOPs for services rendered outside of the TotalChoice service area. Avera Health Plans issues the member EOBs.

Where can I view claim status and member eligibility?

Participating Providers with both the Avera Health Plans and/or the First Choice Health PPO Network should log in to the Avera Health Plans Provider Portal. If you have not yet set up an account with Avera Health Plans, please register as a new user today. By registering for a provider account, you will be able to access secure provider resources, including:

  • Make claims status inquiries.
  • Check member information.
  • Access the provider manual.

Where should I call for prior authorizations?

Submit prior authorizations like you normally do for all product lines at avera.org/PA.

Where should I call if I have questions?

Call Avera Health Plans at 605-504-3362.