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Reference Sheets by Health Plan
Beechstreet
Evolution Health Care
Evolutions Prime Care
Interplan
HealthEase
- HFNI Referral Form
- HealthEase Formulary Quick Reference Sheet (PDF)
- Healthease Medicaid Reference Sheet (PDF)
- Services Requiring Authorization for HealthEase (PDF)
- Medicaid 2008 OTC Product List (xls)
- Well Child Visits (PDF)
- Specialty Providers by Healthplan (PDF)
- Child Health Check-up Codes (PDF)
- HealthEase Injectable Infusion Form (pdf)
- Medicaid Cough & Cold Alternative Drug List (pdf)
Vista Healthy Kids
- HFNI Referral Form
- Services Requiring Authorization for Vista Healthy Kids (PDF)
- Vista Healthy Kids Reference Sheet (PDF)
HealthSpring
- HealthSpring Reference Sheet
- HFNI Referral Form
- Durable Medical Equipment Request
- Request for IV Home Care Services Authorization
- Power Mobility Device Request
- Home Health Care Request
- Precertification Form
- Services Requiring Authorization for HealthSpring
Vista
- HFNI Referral Form
- Services Requiring Authorization for Vista Healthplan (PDF)
- VISTA Pre-Authorization Rules (PDF)
- VISTA Reference Sheet (PDF)
- Vista Formulary
WellCare
- HFNI Referral Form
- WellCare 2008 Benefit Overview (PDF)
- Services Requiring Authorization for WellCare (PDF)
- Wellcare Medicare Advantage Reference Sheet (PDF)
- WellCare/HealthEase Formulary Quick Reference Sheet (PDF)
- PFFS, Medicare 2008 OTC Product List (xls)
- Medicare Part B Immunization Billing Guide (PDF)
- Specialty Providers by Healthplan (PDF)
- Wellcare Injectable Infusion Form (pdf)
- WellCare Formulary
The 2009 WellCare Formulary List is now available to receive a copy please email Jenny Caillouet at jcaillouet@hfni.com or contact our office directly at 850-438-0818.