Connect Archives

August 2009

Saturday, August 01, 2009

Update on HealthEase Contract Termination

The termination date for the Health First Network, Inc. (HFNI) contract with HealthEase to provide Medicaid Services is August 31, 2009. Current HealthEase members assigned to Health First Network Physicians will transition enrollment to Medicaid or Medipass on September 1, 2009. Health First Network is holding Transition of Care meetings with the State and the Health Plan at regular intervals to ensure as smooth a transition as possible.

To keep you updated on transition of care issues and responsibilities, Health First Network is posting all real-time information on the transition on the hfni website as soon as it is available. This memo and the attached Q & A Spreadsheet provide additional information to you and your office staff on the transition of care.

Continuity of Care: Health First Network inquired what our/your responsibilities are for continuity of care after August 31, 2009 for the HealthEase patients you are currently seeing. The HealthPlan and AHCA have advised us that Health First Network has no responsibility for continuity of care after August 31, 2009.

Claims: HFNI Provider claims for service rendered on or before August 31, 2009, need to be submitted within 180 days of the contract termination. Send claims to MED3000 Health Solutions, P.O. Box 11127, Pensacola, FL 32524.

Referrals and Authorizations prior to August 31, 2009: MED3000 will continue to authorize medically necessary covered services through August 31, 2009.

Referrals after August 31, 2009: After August 31, 2009, all referrals to specialists on former HealthEase members will require authorization by the new Medipass Primary Care Physician. We have been advised that Primary Care Physicians or Specialists who do not have a current Medicaid Provider ID Number will not be paid for services provided to Medicaid beneficiaries after August 31, 2009. The Medicaid claims system has no capability to pay Providers without a current Medicaid number.

Verifying Member Eligibility: After August 31, 2009, to verify the eligibility of a Medicaid beneficiary, Providers will need to go through the Medicaid EDS web portal.

Case Management Services under Medipass: Currently, no Case Management Services are available for Medipass beneficiaries. Primary Care Physicians are expected to provide Case Management and Disease Management services to their Medipass patients. There is limited OB Case Management available through the Healthy Start Coalition, managed by Nurses at the Escambia County Health Department, however, funds are limited for this service and currently there is a shortage of nurses providing this service.

Contact Number For Questions or Assistance with a Medicaid Beneficiary after August 31, 2009: The telephone number of the local Area 1 Medicaid Program office is 850-595-5700.

Health First Network Annual Shareholders Meeting

The Annual HFNI Shareholder’s meeting was held on Thursday, June 4, 2009, at 6:00 P.M. at Health First Network. The HFNI Board of Directors has ratified the Shareholder Election and the results are listed below. The Shareholders have elected to: 1) Retain O’Sullivan, Creel as HFN’s external auditors. Elected to the Board were:

PCP's Wayne Willis, M.D. D. Bruce Young, M.D. Robert Flurry, M.D.

RCP’s F. Brooks Hodnette, M.D. Thomas Tan, M.D.

HFNI OB Providers: Vista Global Authorization

This is a reminder that for Vista members including those members in the Open Access Product. Global OB Services requires an authorization from Med3000.

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PART B VS. PART D VACCINES

Coverage for the Medicare Prescription Drug Benefit, referred to as Medicare Part D, began on
January 1, 2006. CMS revised payment policies for the provision and administration of Part D-
covered vaccines furnished to Medicare-eligible enrollees in January of 2007 and 2008, with a minor
revision in May 2009, creating greater complexity to vaccine billing. There are currently over 20
preventive vaccines covered under Medicare Part D, with several vaccines remaining under Part B.
This has created confusion in Physicians offices related to who to bill and how to bill for these
vaccines. This article presents some updated information and general guidelines on Part B vs. Part
D vaccine coverage issues in 2009 for Medicare-eligible beneficiaries.

For WellCare/Medicare members:
Medicare Part B currently covers the following immunizations: Pneumococcal/pneumonia vaccine;
Influenza virus vaccine;
Hepatitis B vaccine when used to treat individuals at high or immediate risk; and
Other vaccines, such as tetanus toxoid, when directly related to the treatment of an acute injury
or direct exposure to a disease or condition.

If the required vaccine is not among those listed above, it is a Part D vaccine. The Part D program
generally covers those vaccines not available under Part B; however, unlike Part B, the immunizer
may or may not be able to directly bill the Part D sponsor for the vaccine and its administration,
but instead may need to work with the beneficiary and his/her Part D plan to facilitate
reimbursement.

Several options exist for obtaining vaccines for WellCare members under Part D. These include
sending the patient to a Pharmacy, such as Thrif-T Drugs, with a prescription for the medication,
then administering the medication in the office; requesting overnight delivery of the vaccine from
the WellCare Pharmacy ( an example is the Zostavax vaccine which can be sent overnight in a “cold
pack”); having the member pay for the vaccine, then file a “WellCare Direct Member Reimbursement
Form” to the WellCare Reimbursement Department; or using another option - the on-line eDispense
Vaccine Manager. WellCare is a participating health plan with the eDispense Vaccine Manager
program.

There is no cost to the physician to enroll or to process claims through eDispense Vaccine Manager.
The 20+ preventative vaccines now covered under Medicare Part D, including
Zostavax, Menactra, Menomune, Vaqta, Zostavax, Adacel, Devac, Havrix, etc., can be billed directly to
WellCare through this program. EDispense offers on-line, real time, patient co-pay
amounts, office reimbursement or product replacement. Marketing information for Vaccine Manager
indicates it can look up any Medicare Member’s Part D insurance plan and then verify the covered
amount for administered vaccines with contracted plans, and can provide a clean and legible paper
claim form for other Medicare-eligible patients whose plans are currently not under contracted with
eDispense Vaccine Manager. Interested offices can enroll at: https://enroll.edispense.com or call
866-522-3386 for further information.

Please refer to the following web address for revised information and reimbursement regarding
Medicare Part D Vaccine Administrations in 2009.
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0727.pdf

For member questions on their Part D coverage issues and co-pay amounts, the most helpful
information you can give your patients is to instruct them to go to their Part D Plan for an
explanation of coverage.

Administration of IV Bisphosphonates and other Injectable Osteoporosis Medications in the Office:
Health First Network has received inquiries about in-office IV infusions or injections of various
osteoporosis medications. One inquiry was on quarterly Boniva IV injections as an alternative to
patients who have difficulty with oral dosing restrictions, such as difficulty swallowing, cannot
sit or stand for 30-60 minutes, taking many other pills, cannot fast (postpone food or drink) or
simply forget to take their oral osteoporosis medicine. The one 3mg Boniva injection referred to is
given intravenously over 15-30 seconds every 3 months by the physician to build and maintain bone
density for these patients.

The following information is provided to you for WellCare Medicare Advantage members.

For WellCare members:
In the Provider office setting for WellCare members, Boniva IV infusion/injection given by the
Physician is covered under the member’s Part B benefit. Because IV Boniva in the office is
considered Step Therapy, it requires approval through a Prior Authorization process with the
completion of a Drug Evaluation Review Form (DER Form) faxed to the WellCare Pharmacy.
Documentation will need to be provided to show that the patient either failed other oral
Bisphosphonate Therapy, was not a candidate for other osteoporosis medications, or that additional
clinical reasons exist for the initiation of injectable Boniva. The WellCare DER form for Prior
Approval and the WellCare Pharmacy fax information can be found on the hfni website ( from the
www.hfni.com home page, go to Physicians and Providers, tab down to Reference Sheets, click on
WellCare, tab down to DER form). Once the office has received the approved DER form back from the
WellCare Pharmacy, they should contact MED3000 Referral Department prior to the administration of
the medication for an authorization number in order to receive reimbursement for the visit and
Boniva Infusion in the office. For Part B medications, typically the member will owe a 20% co-pay
amount.

There are an increasing number of injectable osteoporosis medications available. When infused
intravenously in the office setting, these drugs are considered Part B drugs under Medicare. If the
drug is injectable, and can be self-injected, then Part D benefits will apply.


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HEALTH FIRST NETWORK SPONSORS 2009 PENSACOLA SENIOR GAMES

Health First Network is pleased to announce their sponsorship of the 2009 Pensacola Senior Games which begin September 14, 2009 and continue through September 25, 2009.

The City of Pensacola Senior Games, organized through the Pensacola Department of Parks and Recreation ( “It Starts, In Parks”), provides seniors age 50 and older the opportunity to compete in 21 events ranging from golf and bocce, tennis and swimming, horseshoes and darts, track and field events, shuffleboard and bowling. These and other active events will be held at various Pensacola city parks, community centers, bowling lanes and golf courses. Supported by the Florida Sports Foundation, the local Pensacola games along with games in 11 other Florida cities throughout the State will qualify for the State Senior Championships to be held December 5-13,
2009 in Cape Coral, Florida. From the State level, Senior Champions are challenged to continue competition at the Nationals.

In addition to sponsoring the Senior Games, several Health First Network employees will actively participate in several of the events. Charles Brewer, Dr. William Whibbs and Jenny Caillouet will be competing in the games. Watch for pictures in the next HFNI e-newsletter!

This year’s closing ceremony for the Senior Games will be held at the brand new Sanders Beach Corinne Jones Community Center on Friday, September 25th from 6-9 PM to celebrate the accomplishments of all participants.