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The HealthSpring Medicare Advantage Plan

September 23, 2008

The HealthSpring Medicare Advantage Plan is a Medicare Managed Care Plan, new to our service area, that will give Medicare beneficiaries an additional choice for their quality healthcare coverage. This plan, unlike some others, has been evaluated by HFNI, and it is now one of our contracted plans. CMS has approved for HealthSpring to expand their services into the NorthWest Florida area. HealthSpring is one of the largest Medicare Advantage Coordinated Care Plans offering extensive, affordable health care coverage for people on Medicare.

This contract is for professional services, including credentialing. Health First Network will be responsible for coordinating referrals from physician to physician, and for services provided in physician office settings (place of service 11).

All inpatient and outpatient services that take place in settings other than physician offices (place of service other than 11) will require an authorization from HealthSpring, similar to our contract with Vista. To facilitate the authorization process for these services, HFNI will post all of the necessary forms and instructions on our website (www.hfni.com), and we will also maintain a current list of providers of ancillary services (lab, OP surgical and diagnostic centers, DME, wound care, pharmacy to name a few), and appropriate contact information for HealthSpring clinical personnel.

Inpatient concurrent review will be provided by MED3000 personnel, and coordinated with the HealthSpring medical review team. Case management and disease management programs will also be coordinated by HealthSpring.


HFNI will continuously monitor operations locally, and will be available to assist with your questions or clarifications on authorization procedures and requirements, financial and reimbursement concerns, review criteria, appeals procedures, or any other areas of interest.

We are looking forward to our new partnership with HealthSpring. As with all Medicare managed care, Risk Adjusted Payment Schedules (RAPS) are applicable, and require accurate and complete diagnosis coding and documentation to assure appropriate funding, and PQRI reporting is appropriate.

Dr. Whibbs will be available to assist with any questions. You may contact him at the Health First Network office at 850-434-8147.

https://www.healthspring.com/


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