Reference Sheets by Health Plan

• HFNI Referral Form

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• HFNI Referral Form

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• HFNI Referral Form

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• HFNI Referral Form

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• Well Child Visits (PDF)
• Child Health Check-up Codes (PDF)
• HFNI Referral Form
• Services Requiring Authorization for Vista Healthy Kids (PDF)
• Vista Healthy Kids Reference Sheet (PDF)
• Vista Healthy Kids Ancillary List
• Appeal/Medical Review Submission Form (pdf)

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• HealthSpring Reference Sheet
• About HealthSpring (pdf)
• 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
• HealthSpring Transportation Benefit
• HealthSpring Ancillary List
• Appeal/Medical Review Submission Form (pdf)
• HealthSpring 2009 Benefit Grid (pdf)
• Flu Shot Clinics for HealthSpring Members (pdf)
• Diabetic Testing Supplies (pdf)

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• HFNI Referral Form
• Services Requiring Authorization for Vista Healthplan (PDF)
• VISTA Pre-Authorization Rules (PDF)
• VISTA Reference Sheet (PDF)
• Vista Formulary
• Vista Ancillary List (PDF)
• Appeal/Medical Review Submission Form (pdf)

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• HEDIS Quick Reference and Coding Guide for Physician Offices
• 2010 WellCare Medicare Formulary Changes (additions and deletions)
• WellCare Special Needs Plan (SNP)Model of Care Training program
• HFNI Referral Form
• WellCare 2009 Benefit Overview (PDF)
• Services Requiring Authorization for WellCare (PDF)
• Wellcare Medicare Advantage Reference Sheet (PDF)
• WellCare Formulary Quick Reference Sheet (PDF)
• Medicare 2009 OTC Product List (xls)
• Medicare Part B Immunization Billing Guide (PDF)
• WellCare Medicare Specialty Providers (PDF)
• Wellcare Injectable Infusion Form (pdf)
• Wellcare Ancillary List (pdf)
• Appeal/Medical Review Submission Form (pdf)
• Drug Evaluation Review Form – Florida (pdf)
• WellCare Pharmacy Direct Member Reimbursement Form for Part D Vaccines and other Rx's (pdf)
• WellCare Direct Member Reimbursement Form CCP (pdf)
• 2009-2010 Flu Season information and guidelines for submission of Influenza Vaccination Claims (pdf)
• Behavioral Health Referral Form (pdf)
• Sample - Authorization Approval Letter to Members (pdf)
• 2010 WellCare Formulary Updates (pdf)
• WellCare Formulary
  To receive a copy please email Jenny Caillouet at jcaillouet@hfni.com or contact her directly at 850-438-4887.

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