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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• 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)

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• HFNI Referral Form
• Services Requiring Authorization for Vista Healthy Kids (PDF)
• Vista Healthy Kids Reference Sheet (PDF)

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• 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

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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

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• 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.

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