Connect Archives

August 2010

Friday, August 27, 2010

HUMANA

We are pleased to announce that Health First Network has signed an agreement with Humana to participate in their HMO Medicare Advantage product. Humana has not had an HMO product in the area before but they have offered both the Private Fee For Service Product (PFFS) and a Preferred Provider Organization Product (PPO). This new HMO product will be effective 01/01/11. Currently Humana has approximately 3,500 members in PFFS and PPO. They expect that with conversions from those two products and new sales they will have about 2,000 members in the Humana HMO product after open enrollment. HFNI will be at risk for this product. As such we will be responsible for physician network development, credentialing and medical management. PCP claims will be paid locally and all other claims will be paid by Humana.

This is a testament to the strength of Health First Network that Humana chose to offer a product of this nature only after reaching an initial agreement with HFNI. We have a well deserved reputation for dealing with the physicians fairly while delivering quality products for the members, your patients.

Please give this product your immediate consideration. Please direct any questions that you may have to Jenny Caillouet, Manager of Network Development.

DR. TAN RESIGNS FROM THE BOARD OF DIRECTORS / HFNI WELCOMES DR. BERNSTEIN AS THE NEWEST MEMBER OF THE BOARD OF DIRECTORS

After many years of service on the HFNI Board of Directors, Dr. Tom Tan decided his commitments in other areas no longer allowed him to devote the necessary time to participate as a member of the Board. Dr. Tan has been a key member of the Board serving on both the Finance Committee and the Executive Committee. His leadership and thoughtfulness have been instrumental in the development of Health First Network. We wish Tom well in his practice and with his new venture at The Woodlands.

To replace the departing Dr. Tan, the Board unanimously approved Dr. David Bernstein to fulfill his term. As most of you know, Dr. Bernstein is a Urologist having been a member of Health First since 1995. Dr. Bernstein has participated with various aspects of HFNI before and his knowledge of the community should prove to be a useful resource. Please join us in welcoming Dr Bernstein.

NEW AUDIOLOGY FACILITY

The Health Services Department of the Escambia County School District has notified HFNI that the Audiology Clinic of Escambia County Schools has moved and is open for business. The facility is now located at Holm Elementary School, 6101 Lanier Drive, Pensacola, FL, 32504 (near where Langley and 9th Avenue intersect).

This new facility has state-of-the art audiology equipment and experienced audiologists. They are able to take referrals for Escambia County students pre-school age, 2½ to 3 years, through 21 years of age. In addition, if a Pediatrician or Family Practice Physician suspects hearing loss in an infant as young as 12 months of age, this facility will accept the infant for audiology screening and testing. Unfortunately, at this time, they are not taking referrals for Santa Rosa County school children.

To refer a child for Audiology screening and testing, Providers may call the clinic at 850-471-6001, or fax a request to the clinic at 850-471-6003.

MAGELLAN BEHAVIORAL HEALTH SERVICES TRANSITION FOR WELLCARE MEMBERS

WellCare Health Plan recently entered into an agreement with Magellan Behavioral Health, Inc, for Magellan to administer all behavioral health benefits for all WellCare members in the State of Florida beginning August 16, 2010.

Please note that this does not change any behavioral health services covered by WellCare. The benefits remain the same.

To obtain behavioral health authorizations and referrals for WellCare members for dates of service on or after August 16, 2010, you must call Magellan at 1-877-712-5340.

Claims for behavioral health services provided to WellCare members for dates of service on August 16, 2010 and later must be submitted directly to Magellan. Providers can visit the Magellan Provider Welcome web site for additional information, such as services requiring prior authorization and how to submit claims to Magellan.

If a WellCare member has questions regarding his or her behavioral health benefits, they should contact the WellCare Customer Service Team at the following number: 1-888-888-9355.

Related Links


REMINDER REGARDING PHYSICIAN EXTENDERS

This is a reminder that effective July 1, 2010 HFNI began processing claims for physician extenders in the same manner as Medicare. One implication of this is that all physician extenders must be credentialed.

Please be advised that just as it is your responsibility to inform HFNI of additions/changes to the physician(s) in your office, it is also your responsibility to provide credentialing information for your non-physician extenders to Health First Network and to keep that information current. You should contact Jenny Caillouet at 438-4487 to receive applications for your extenders, if you have not done so at this time.

HEALTHPLAN CONTRACTED LABS

A quick reminder to Physician Offices when ordering lab tests on managed care patients:

Each Health Plan has a contracted, capitated lab vendor that members are required to use. When members are directed to non-participating, non-contracted labs they risk having the claim denied or possibly incurring a larger co-pay for the service.

Current, up-to-date Quick Reference Sheets with information on contracted labs for each healthplan can be found on the hfni website in the Physicians/Providers section.

For WellCare members, the contracted lab is Quest. For VISTA/Coventry Commercial and Healthy Kids, the contracted lab is LabCorp. For HealthSpring members, the contracted lab is LabCorp.

Related Links


REVISIONS TO STAT LAB LIST FOR WELLCARE MEMBERS

Health First Network has recently added CPT Code 81003 ( Urinalysis, automated, without microscopy) to the WellCare STAT Lab List.

The STAT Lab List for each healthplan is a listing of lab codes for lab tests that may be performed in Physician office without the requirement that the member be sent to the contracted lab for the lab draw and test. These are tests that results are needed quickly on for the Physician to make a determination on a treatment decision for the member.

Related Links