Connect Archives

October 2008

Wednesday, October 01, 2008

The HealthSpring Medicare Advantage Plan

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.

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e-INFOsource – New system implementation

MED3000 is undertaking a new system implementation for their client Health First Network. The new system is expected to move into production October 1, 2008. Processing for claims prior to October 1st will be processed in the existing system and claims for service dates beyond the 1st of October will be processed in the new system.

With this implementation, the web portal Infosource will also undergo change. A direct link from the current portal login screen to the new site for eINFOsource will be provided when this change occurs. eINFOsource provides the ability to validate eligibility, view claim status and to initiate authorizations. Training for eINFOsource is available now. MED3000 has developed a series of E-Learning tools enabling users to train at their convenience.

eINFOsource is designed to streamline many of the day-to-day administrative activities within the physician office. Health First Network and MED3OOO encourage the use of these tools. Questions regarding the new system implementation, how to obtain access to eINFOsource, and the available training should be directed to the Provider Network Support Help Desk at (850) 505-4090 or toll free (866) 703-1444.

Healthy Kids Product awarded to Vista Healthplan (Coventry)

Effective October 1, 2008, the Healthy Kids product for both Escambia and Santa Rosa Counties have been awarded to Vista Health Plan (Coventry). Prior to this time Healthy Kids in Escambia County was through HealthEase and was contracted through Health First Network. Santa Rosa County was through Blue Cross and Health First was not involved.

Health First Network will be responsible for providing professional services for this product in both counties. We will operate the Healthy Kids in the same manner as Health First currently provides services for the Vista Commercial HMO products. To you, this means that referrals for professional services will be approved through Health First Network while authorization for facility based services will be through Vista. The list of services requiring pre-authorization for Vista Healthy Kids will be placed on the HFN website, www.hfni.com.

It is important to note that we have made an effort for all of the children to remain with their current primary care physician. HFN provided a list of the Escambia members and their respective PCP to Vista for them to load in their system. It is our understanding that Blue Cross did the same for the Santa Rosa members.

Please email Jenny Caillouet at JCaillouet@hfni.com or call her at 850-438-4487 with any question or concerns you might have.

Child Health Check-ups

Well Child visits are the hallmark of preventative care for infants and children. They provide an excellent opportunity for prevention or early intervention of physical, developmental and behavioral problems. To learn more about the importance of child health check-ups and for the list of child health check-up codes follow the links below.

Related Links


Child Health Check-ups

Well Child visits are the hallmark of preventative care for infants and children. They provide an excellent opportunity for prevention or early intervention of physical, developmental and behavioral problems. To learn more about the importance of child health check-ups and for the list of child health check-up codes follow the links below.

Related Links