Connect Archives

September 2016

Friday, September 30, 2016


HFNI has rescinded the cancellation of its Humana Medicaid contract. We have reached an agreement with Humana which calls for HFNI to work with Humana and our network physicians to improve quality scores and access. We are excited about this opportunity to work with Humana and you to provide support to your patients.


As part of Humana’s focus on preventive health, they want all infants and children to receive recommended immunizations and screenings.

Vaccines for Children Program:
As a Medicaid plan provider, Humana is required to remind health care providers annually regarding their participation in the Vaccines for Children (VFC) program, as detailed under section 1928 of the Social Security Act. The VFC program is administered by the Department of Health, Bureau of Immunizations. The program provides vaccines at no charge to physicians and eliminates the need to refer children to county health departments for immunizations. Please note: Title XXI MediKids enrollees do not qualify for the VFC program and must be billed directly through the Medicaid fee-for-service delivery system for immunizations provided to them.

Child Blood Lead Screenings:
Federal regulations also require that children receive a blood screening for lead test at 12 months old and at 24 months old. Children aged 36 to 72 months who have not previously been screened also should be screened for lead poisoning. Humana recommends that health care providers use a verbal lead-screening questionnaire to assess the risk of elevated levels in children 6 months to 6 years old. Taking Centers for Disease Control and Prevention (CDC) guidelines and recommendations into account, children whose blood lead levels are found to be 10 mcg/dL or greater (by venous sampling) should be treated and managed according to the physician’s discretion. Follow-up visits should include identification of possible sources of lead, appropriate treatment and periodic repeat testing.

If you have questions regarding the VFC program or blood lead screenings, please contact the Humana Quality Management department at 305-626-5252.


WellCare is now offering a bonus incentive to providers who use RxEffect® to identify and take action for Star Ratings medication therapy areas: Blood Pressure, Cholesterol and Diabetes.

Earn $50 per qualifying member therapy between October 1, 2016 and December 31, 2016. Bonus eligibility is dynamic and will be updated each business day. Log in and review your patient list frequently.

Incentive Eligibility
To receive your bonus, you must take the following steps:
1. Visit to review the patient therapies eligible to receive a bonus.
2. Take the necessary action to make the patient adherent for that therapy while eligible for the bonus.

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HFNI’s ACO partner, Collaborative Health Systems (“CHS”) served notice of intent to no longer be a member in the Accountable Care Coalition of Northwest Florida ACO (“ACCNWFL”) and terminated the CHS/HFNI Delegation Agreement and its funding of delegated activities including Care Coordination on August 31, 2016. As a result, HFNI has suspended direct RN Care Coordinator activities.

HFNI is evaluating its options regarding the ACCNWFL ACO including discussions with potential capital partners and will provide further information in the near future.

As always, please contact any HFNI manager should you have specific questions.


The 2015 Physician Quality Reporting System (PQRS) feedback reports will be available in September 2016 for individual eligible professionals (EPs) and PQRS group practices. The PQRS feedback reports will provide the final determination on whether or not participants met the PQRS criteria for avoiding the 2017 PQRS negative payment adjustment. Detailed information about the quality data submitted by the provider is also included.

The 2015 PQRS feedback reports reflect data from the Medicare Physician Fee Schedule (PFS) claims received with dates of service from January 1, 2015 – December 31, 2015 that were processed into the National Claims History (NCH) by February 26, 2016. A PQRS feedback report will be generated for each Taxpayer Identification Number/National Provider Identifier (TIN/NPI) combination that reported PQRS data or that submitted Medicare PFS claims that included denominator-eligible events but did not submit PQRS data. The feedback reports will include all measures reported by the NPI for each submission mechanism used. The data in these reports may help an individual EP or PQRS group practice determine whether or not it is necessary to submit an informal review request. Detailed submission information for PQRS group practices that submitted via the GPRO Web Interface will be available in the Quality and Resource Use Reports (QRURs).

Additional information about the 2015 PQRS feedback reports and how to request an informal review will be available on the PQRS website and through the QualityNet Help Desk at 1-866-288-8912 or

The 2015 Annual Quality and Resource Use Reports (QRURs) will also be available in September 2016 for groups with 2 or more EPs and solo practitioners. Groups and solo practitioners are identified in the QRURs by their TIN. The QRURs are also available for groups and solo practitioners that participated in the Medicare Shared Savings Program, the Pioneer Accountable Care Organization (ACO) Model, or the Comprehensive Primary Care initiative in 2015, and to those TINs consisting only of non-physician EPs.

The 2015 Annual QRURs show how groups and solo practitioners performed in 2015 on the quality and cost measures used to calculate the 2017 Value Modifier. For physicians in groups with 2 or more EPs and physician solo practitioners that are subject to the 2017 Value Modifier, the QRUR shows how the Value Modifier will apply to physician payments under the Medicare PFS for physicians who bill under the TIN in 2017. For all other groups and solo practitioners, the QRUR is for informational purposes only and will not affect their payments under the Medicare PFS in 2017.

Authorized representatives of groups and solo practitioners can access the 2015 PQRS feedback reports and 2015 Annual QRURs on the CMS Enterprise Portal using an Enterprise Identify Data Management (EIDM) account with the correct role. For more information on how to access these reports, follow the link below: How to Obtain a QRUR.

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Health First Network, Inc. (HFNI) has formed the HFNI Professional Liability Insurance Program, a program designed to enhance the professional liability coverage of our members with available discounts of up to 50% for qualified members.

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Did you receive money back on your Workers’ Comp Premium last year? Now you are eligible through the Health First Network Workers’ Compensation Program.

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Due to HFNI’s rejection of our exchange vendor’s unilateral cessation of essential services, HFNI will no longer be offering a private insurance exchange.


Most physicians look at social media marketing as a luxury and not a necessary part of their business. The healthcare industry consistently sets the pace for innovative science and technology, yet at the same time struggles to keep up in marketing and patient engagement. Social media has proven to be an important and essential communication tool for community engagement and healthcare branding.

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Ron Meritt
President, On Advertising

Ron has more than 20 years of marketing, advertising, public relations, reputation and crisis management experience in the healthcare industry. From physician marketing for business development to reputation management to crisis management, Ron has done it all. As President of On Advertising, he guides the strategy, client service and performance for all clients in the agency. He does this by uniting a unique combination of strategic thinking and business innovation and then engages tactics designed to increase short and long-term business development for the client.

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The HFNI Office Depot/OfficeMax Discount Program

HFNI Members, get custom-discounted pricing and more with your Store Purchasing Card. When you shop at any Office Depot or Office Max store, you’ll always get the lower of the retail store price or your custom-discounted price.

Plus, get deep discounts on black & white copies, color copies, binding, folding and cutting at our Copy and Print Center.

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