New!

• 2011 Code of Ethics, 8th edition
• Corporate Compliance Hotline
• Converting to ANSI 5010: We're here to help get you there
• 2011 coverage for preventive services
• Proper use of modifiers (-25, -59, -50)

Referrals

• Referral form - For HMO referrals to an in-network specialist, or for out-of-network services

Provider directories

• Physician acceptance form - for established members

Commercial groups

• Search for physicians
• Ancillary services
• Complete directory

Medicare

• Search for physicians
• Ancillary services
• Complete directory

Authorizations

• Authorization list - Effective February 1, 2012: procedures that require pre-certification
• Authorization list changes - Highlights items that have changed since the previous version
• Authorization list codes - Reference list of codes for procedures included on the Authorization List
• Auth requirements for DME, prosthetics, and orthotics
• Authorization request form
• Pharmacy authorization request form
• Pharmacy authorization criteria
• SNF interdisciplinary nursing report
• Skilled nursing therapy team update

For non-emergent imaging procedures:

• Physician's guide to precertification through American Imaging Management (AIM)
• AIM authorization list - Radiology procedures that require authorization
• AIM precertification request - Fax form
• AIM Q&A - Frequently asked questions about the American Imaging Management/ HFHP diagnostic imaging program

Prescription drugs

• Pharmacy authorization request
• Pharmacy authorization criteria

Commercial group formularies

• 5-tier commercial group drug list
• 3-tier commercial group drug list

Medicare formularies

• 2012 Rewards/Value/Classic
• 2012 Employer Groups
• 2012 PDP Essential
• 2012 PDP Prime

Claims

Please remember to use the following mailing addresses for new claims:

Health First Health Plans
PO Box 69355
Harrisburg, PA 17106-9355

For information on submitting claims electronically, please visit Claimsnet or call 1-800-356-1511.

Claim dispute form
Corrected claim form modifier 25/59
Proper use of modifiers (-25, -59, -50)
Provider waiver to initiate Medicare Advantage claim appeal

Changing network status

To ensure a proper continuum of care for our members, it is imperative that we receive a 60-day written notice from any provider office intending to change network status. This includes not accepting new patients, or leaving the network. Your cooperation is greatly appreciated. (Request must be submitted in writing.)

Other

• ID cards - Examples of our member ID cards