Connect Archives

January 2009

Thursday, January 1, 2009

Changes to Referral Pre-Auth. Requirements

Health First Network recently made changes to the Referral Pre-Authorization Requirements for VISTA, 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.

New additions to our website

Health First Network is pleased to announce several new additions to our website.

First, we added a number of downloadable forms under the Reference sheets by health plan section. Here you can locate: referral forms, pre-certification forms, formularies, services requiring authorization, reference sheets (who to call) and a number of other forms which can be of help to our physician offices.

Secondly, we have expanded our Physicians Resources and Education page to include links to various websites offering Continuing Medical Education credits. There are over 1600 Hours of CME credit hours available for Primary Care Physicians and Specialists.

And lastly, under our Commonly Used Forms page, we have added downloadable school forms, a drug evaluation form, and a commercial driver – physical examination form.

We hope that you find these new additions useful.

HealthEase Formulary and Quick Reference Sheets

A complete list of covered prescription medications is posted below.

As Formulary Updates and Quick Reference Take Away Sheets become available from HealthEase Health Plan and other plans, Health First Network will post them on the website.

Health First Network thanks you for your participation in the HealthEase product and for your exceptional service and care of these members.

Related Links

2009 HealthEase Medicaid Cough and Cold Alternative Drug List

The cough and cold season is always a busy time of year for Primary Care Physicians. To assist Physicians who care for HealthEase members, the HealthEase Pharmacy Department has compiled a list of the most common cough and cold medications that are available with a prescription for Florida HealthEase Medicaid members. Since there are numerous products available to treat the symptoms of cough and cold, and many are non-formulary products or combination drugs, this list was created as a reference for Physicians. Please refer to the Medicaid Cough and Cold Alternative Drug List for the complete list of those drugs which are non-formulary and those that are Preferred Formulary Drugs.

Related Links

Health First Network helps to support the Fricker Community Center’s Children’s Christmas Event

Creatively and energetically, Health First Network staff helped harness resources to support a Children's Holiday Party on December 20, 2008, at the Fricker Community Center. Called on to support a Children's Christmas Event for approximately 200 youth and their families, who attend the Fricker Community Center's After-School Program, Health First Network coordinated with partner healthplans, VISTA, HealthEase and Blue Cross/Blue Shield, to provide an enjoyable, memorable event for what turned out to be over 350 children and their families. The event included singing Christmas Carols, the reading of the Bethlehem Christmas Story by a local pastor, Christmas gifts for each child attending, a visit with Santa Claus, school supplies for each child for the remainder of the school year, a healthy snack, and a variety of games and music for the children to participate in.

The Fricker Community Center is located in an area where the children face obstacles and life changing challenges on a daily basis. The staff at the Community Center faced a lack of resources for the Holiday Event. Health First Network learned of the need during a meeting of the Unite Escambia's Health Solution Team. The Fricker Center is participating in the Team's "We Can" program to provide health education, nutrition information and better preventive health resources to the children at the Community Center.