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Changes to Referral Pre-Auth Requirements

December 8, 2008

Health First Network recently made changes to the Referral Pre-Authorization Requirements for VISTA, VISTA Healthy Kids, and WellCare. These changes will be positive time-savers for both PCP and Specialist offices.

Below is a brief summary of the changes.

For VISTA, VISTA Healthy Kids, and WellCare:
Extended PCP to Specialist Referrals to 12 months/ 12 visits.

For WellCare:
Removed Pre-Auth requirements to a Participating Provider for the following services:
• Chemotherapy
• Radiation Therapy (Oncology) Services
• DME purchases less than $500.00
• Outpatient Hospital Therapy Services, P.T., O.T., S.T.
• Dialysis

These changes were approved by the Health First Network Finance and Executive Committees, and the HFN UM/QM Committee. They are based on a thorough 12 month review of claims, referral approvals and denials, and input from HFNI Physicians. Effective date for these changes is December 1, 2008.

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