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Healthplan Information
Coventry (Vista)
- Contract Change Notice to Providers
- Freestanding Facilities Coventry
- Coventry (Vista) Formulary
- Letter to Providers regarding Prior Authorizations
- Pre-Authorization Quick Reference Guide
- Pre-Authorization Rules
- Medical Prior Authorization Request Form
- Stat Lab List
HealthEase/Staywell
- HealthEase Quick Reference Guide
- HealthEase Provider Forms
- Medicaid Preferred Drug List
- WellChild Visits
- CareCore National Frequently Asked Questions (FAQ's)
> Link to CareCore National Website - Medicaid Coverage Determination Request Form
- Medicaid Injectable Infusion Form
HealthSpring
- HealthSpring Reference Sheet
- Services Requiring Authorizations
- HFNI Referral/Authorization Request Form
- HealthSpring Precertification Form
- In-Office Lab List
- Home Health Care Request
- Durable Medical Equipment Request
- Request for IV Home Care Services Authorization
- Power Mobility Device Request
- The formulary for each of the different plans offered can be found on this page:
HealthSpring Formularies - Diabetic Testing Supplies
- Transportation Benefit
- Claim Medical Submission Form
- Appeal Submission Form
- HealthSpring Partnership for Quality Program
- CMS updates for CLIA-related Changes for 2012 - New CLIA Tests effective January 3, 2012
Staywell Kids
- Staywell Kids Quick Reference Guide
- Staywell Kids Provider Forms
- Medicaid Preferred Drug List
- Medicaid Coverage Determination Request Form
- Medicaid Injectable Infusion Form
WellCare
- WellCare Quick Reference Guide
- WellCare Provider Forms
- Behavioral Health Referral Form
- WellCare No-Auth. Required Drug List
- WellCare Coverage Determination Request Form
- Step Therapy Drug List
- WellCare Prior Authorization Protocols 2011
- WellCare Injectable Infusion Form
- Mail Order Member Registration and Prescription Mail Order Form
- Mail Order Pharmacy Prescription Form
- Diabetic Supply Order form
- WellCare Selected Drug Costs 2012
- Pharmacy Direct Member Reimbursement Form for Part D Vaccines and other Rx's
- Medicare Part B Immunization Billing Guide
- HEDIS Quick Reference and Coding Guide for Physician offices
- CareCore National Frequently Asked Questions (FAQ's)
> Link to CareCore National website - CMS updates for CLIA-related Changes for 2012 - New CLIA Tests effective January 3, 2012
- WellCare 2013 Comprehensive Formulary
- WellCare Health Plan has notified Health First Network that the new preferred Glucometer brands for 2013 are Roche (AccuChek) and Abbott (Freestyle and Precision). In an effort to let each office have up to 12 meters available for their patients, Abbott Health Care Profession has an assortment of meters available for free to offices. Please see the attached meter form for details. Remember that additional test strips for these meters will require a prescription.
Meter Fax Form - WellCare Health Plan has notified Health First Network that their vendor will be sending out letters to each of our WellCare Physicians, providing them with a list of members with gaps in Pharmacy-related CMS Star Ratings. HFNI encourages Physicians to review their reports and consider the information on individual non-adherence and quality measures listed on their patients. Since the pharmacy benefit is a significant component of Part C Health Plans, and the primary objective of Part D plans, attention has shifted to Health Plan Pharmacy Departments to deliver winning strategies to improve health plans’ star ratings.
The five-star (STAR) Rating System is a quality and performance scoring method designed by the Center of Medicaid and Medicare Services (CMS), and used for certain health plans offering healthcare services to Medicare beneficiaries. This rating system is used to provide a scored assessment of individual quality components as well as aggregate overall performance of private Part C (Medicare Advantage [MA]) and/or Part D (Prescription Drug Plans [PDP]) plan(s). The Patient Protection and Affordable Care Act and the HealthCare Education and Reconciliation Act of 2010 (the Affordable Care Act) introduced quality-based payments and quality bonus payments (QBPs) as an incentive to encourage these health plans to accelerate the implementation of quality program improvements.
Based on a three-year CMS demonstration project from 2012 to 2014, plans achieving or exceeding the “average performer” rating of 3 stars or better in its overall star ratings will receive bonus payment percentages based on their overall STAR rating. After this demonstration project is completed in 2014, bonus payments will only be awarded to plans with at least 4 stars.
WellCare Pharmacy Letter
