Connect Archives

June 2014

Tuesday, June 24, 2014


HFNI is currently gearing up for the launch of the Managed Medical Assistance program for Medicaid in August. We are working with Humana to develop the program and put in place the resources that will allow us to effectively provide services and medical management for this group of patients. The state of Florida applied for and received a waiver from CMS that allows the state to place all Medicaid beneficiaries statewide in a managed care program, either an HMO (Health Maintenance Organization) or a PSN (Provider Sponsored Network). In the Agency for Health Care Administration (AHCA) Area 1, which is Escambia, Santa Rosa, Okaloosa, and Walton counties, Humana was awarded the HMO contract, and a group called Integral was awarded the PSN contract. HFNI has a contract with Humana; we do not have a contract with Integral. We are anticipating about 60,000 Medicaid beneficiaries overall as a result of this program.


Care coordination in the primary care practice involves deliberately organizing patient care activities and sharing information among all of the participants concerned with a patient's care to achieve safer and more effective care.

The main goal of care coordination is to meet patients' needs and preferences in the delivery of high-quality, high-value health care. This means that the patient's needs and preferences are known and communicated at the right time to the right people, and that this information is used to guide the delivery of safe, appropriate, and effective care.

Our ACO Care Coordinators are dedicated to the patients and their providers by improving the quality, appropriateness, timeliness, and efficiency of clinical decisions and care, thereby improving the quality and efficiency of health care overall.

Listed are the providers and their assigned ACO Care Coordinator:
Janet Blough-Black, RN (ACO Care Coordinator) (850) 324-9296
Hillary Hultstrand, M.D.
Jennifer Miley, M.D.
Karen Snow, M.D.
David Kellen, M.D.
William Zimmern, M.D.
Karen Pennington, M.D.
Anita Westafer, M.D.
Brooks Hodnette, M.D.
Paul Pandolfi, M.D.
William Howe, M.D.
William Wilson, D.O.
John Brown, D.O.
Wayne Willis, M.D.

Pamela Shelton, RN (ACO Care Coordinator) (850) 572-0214
Manuel Abendan, M.D.
Ronald Maddux, M.D.
Mary Salib, M.D.
Rogelio Samson, M.D.
George Smith, M.D.
George Soliman, M.D.
Earl Crosswright, M.D.
Manning Hanline, M.D.
Warren Herron, M.D.
Sidney Clements, M.D.
Samuel Greenlee, M.D.
Lourdes Virtusio, M.D.

Robin Abbott, RN (ACO Care Coordinator) (850) 382-3818
C. David Smith, M.D.
Michael Smith, M.D.
Bach-Uyen Le Thi, M.D.
Janet Lewis, M.D.
Dennis Mayeaux, M.D.
David Young, M.D.
Elias Banuelos, M.D.
Flora Cabreros, M.D.
Robert Flurry, M.D.

If you have not been introduced to your care coordinator, please contact Deborah Gant, Director of Health Services at (850) 434-6087 to arrange a visit.


Once again, it’s time for the ACO Annual Compliance Training. The areas that need to be completed are located under the Compliance section of the Training Modules on the CHS website. Training and exams should be completed by 6/30/2014. There are 3 sessions to complete and will take less than 30 minutes. There is a 10 question exam after each session.

The sessions to be reviewed are:
1) Compliance Program Overview
2) Fraud, Waste & Abuse and Other Laws
3) Privacy – HIPPA and PHI

The same user id and password from last year still applies. If you do not remember your password, please follow the links to reset it.

If you have any questions please fill free to contact Amy Ates at 850-434-8082.

Please follow the link below to complete.

Related Links


As a reminder, the voluntary Open Payments registration process for physicians and teaching hospitals (Phase 1) in the CMS Enterprise Portal is currently open. Although registration is a voluntary process, it is required if physicians or teaching hospitals want to access, review, and dispute any of the data reported about them by the industry prior to public posting of the data.

Registration and data submission for physicians and teaching hospitals will be conducted in two phases for this first Open Payments reporting year:
• Phase 1 (currently underway) includes user registration in the CMS Enterprise Portal.
• Phase 2 (begins in July and will extend for 45 days) includes physician and teaching hospital registration in the Open Payments system, and allows them to review and dispute data submitted by applicable manufacturers and applicable group purchasing organizations (GPOs) prior to public posting of the data. Note: Any data that is disputed, if not corrected by industry, will still be made public but will be marked as disputed.

Physicians can learn more about Open Payments requirements by reviewing the Program Overview for Physicians.

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Are you a Medicare provider who was unable to successfully demonstrate meaningful use for 2013? CMS is accepting applications for hardship exceptions to avoid the upcoming Medicare payment adjustment for the 2015 reporting year. Payment adjustments for the Medicare Electronic Health Record (EHR) Incentive Program will begin on January 1, 2015 for eligible professionals.

However, you can avoid the adjustment by completing a hardship exception application and providing supporting documentation that proves demonstrating meaningful use would be a significant hardship for you. CMS will review applications to determine whether or not you are granted a hardship exception. Applications for the 2015 payment adjustments are due July 1, 2014 for eligible professionals. If approved, the exception is valid for one year. CMS has posted hardship exception applications on the EHR website for:
• Eligible professionals
• Eligible professionals submitting multiple National Provider Identifiers (NPIs)

Hardship Exception Tipsheets
You can also avoid payment adjustments by successfully demonstrating meaningful use prior to the payment adjustment. Tipsheets are available on the CMS website that outline when eligible professionals must demonstrate meaningful use in order to avoid the payment adjustments.

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HFNI fielded its first webinar at the end of April. We have another planned for late June, anticipating that by then, we will be able to share more information about the new programs; also we will be updating progress on our URAC accreditation process, and on some new tools we have available to our docs for the Accountable Care Coalition of Northwest Florida (ACCNWFL), our ACO. Future programs will address other currently significant topics. We are working on CME credit for the webinars as well, and we welcome comments and ideas for topics to address that are relevant to our physicians and their offices.


Effective 1/1/14 Health First Network, Inc. (HFNI) / MED3000 is no longer responsible for processing claims for Healthspring Medicare Advantage HMO.

Health First Network, Inc. will continue to work with Healthspring, giving support to our providers for that product.

It is very important that all claims with dates of service prior to January 1, 2014 are filed to HFNI / MED3000 no later than June 30, 2014 at the address below.

HealthSpring Medicare HMO
P. O. Box 11547
Pensacola, FL 32524

All claims received after June 30, 2014 for dates of service prior to January 1, 2014 will be denied timely, NO EXCEPTIONS will be made.

All claims for dates of service after December 31, 2013 should be filed to:

Healthspring Medicare Advantage HMO
P.O. Box 981804
El Paso, TX 79998
Electronic claims: Emdeon Payor ID 63092

Please contact Jenny Caillouet at 850-438-4487 if you have any questions.


HFNI has created a new “Job Postings page” in an effort to help our physician offices fill job vacancies.

If you would like to advertise open employment opportunities on the HFNI website, please contact Jenny Caillouet at 850-438-4487.


Health First Network would like to welcome the most recent physicians to join the Network:
Michael Brooks, D.C. Chiropractic
James Peoples, M.D. Hospitalist
Roger Berkow, M.D. Pediatric Medical Oncology/Hematology
** To determine which health plans each physician is participating in check the “Find A Doctor” section on the HFNI website.

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