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Reference Sheets by Health Plan
Coventry (Vista)
- Contract Change Notice to Providers
- Freestanding Facilities Coventry
- Coventry (Vista) Formulary
- Letter to Providers regarding Prior Authorizations
- Medical Prior Authorization Request Form
- Pre-Authorization Quick Reference Guide
- Up-to-date Current CLIA-Waived Lab Tests 2011
Coventry (Vista) Healthy Kids
- Coventry (Vista) Healthy Kids Reference Sheet
- Services Requiring Authorization
- HFNI Referral/Authorization Request Form
- Claim Medical Review Submission Form
- Appeal Submission Form
- Well Child Visits
- Up-to-date Current CLIA-Waived Lab Tests 2011
HealthEase
- 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 - Up-to-date Current CLIA-Waived Lab Tests 2011
HealthSpring
- HealthSpring Reference Sheet
- Services Requiring Authorizations
- HFNI Referral/Authorization Request Form
- HealthSpring Precertification Form
- 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
- Letter to Physicians on patients needing formulary alternatives or formulary exceptions for 2011
- Letter to Members on 2011 Formulary Changes
- Letter to Physicians on Avandia
- HealthSpring Partnership for Quality Program
- Up-to-date Current CLIA-Waived Lab Tests 2011
- CMS updates for CLIA-related Changes for 2012 - New CLIA Tests effective January 3, 2012
WellCare
- WellCare Quick Reference Guide
- WellCare Provider Forms
- Behavioral Health Referral Form
- WellCare's Authorization Requirements and Case and Disease Management Programs
- WellCare 8/1/11 Transition Notice and Frequently Asked Questions
- WellCare No-Auth. Required Drug List
- WellCare Coverage Determination Request Form
- Step Therapy Drug List
- WellCare Prior Authorization Protocols 2011
- Injectible Infusion Pre-Authorization Form
- Diabetic Supply Order form
- Mail Order Pharmacy Prescription Form
- WellCare Selected Drug Costs 2011
- 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 - Up-to-date Current CLIA-Waived Lab Tests 2011
- CMS updates for CLIA-related Changes for 2012 - New CLIA Tests effective January 3, 2012
