Peach State Health Plan Blog

Dear Provider:

As you know, Peach State Health Plan (Peach State) has partnered with National Imaging Associates, Inc. (NIA) to implement a radiology benefit management program. The high-tech radiology management program is on schedule to begin on August 2, 2010 for the following non-emergent outpatient radiology procedures:
• CT / CTA
• MRI / MRA
• PET Scan

Effective August 2, 2010, providers should contact NIA to obtain authorization for the services referenced above.

Peach State and the Georgia OB/GYN Association continue to work in partnership to address questions submitted by the Association’s member OB/GYNs regarding the implementation of the antepartum testing review program. Therefore, the implementation of the OB Ultrasound program will be delayed pending further communication from the health plan.

We appreciate your continued support and look forward to your assistance in assuring that Peach State members receive clinically appropriate advanced diagnostic imaging services. Should you have questions at this time, please contact your Provider Relations representative at 866-874-0633.

Sincerely,

Peach State Health Plan

This entry is filed under Blog, News.

Dear Peach State Provider:

Peach State Health Plan (Peach State) and the Georgia OB/GYN Association are working collaboratively in partnership to address the questions and concerns raised by the Association’s member OB/GYNs regarding Peach State’s proposed antepartum testing review program to be implemented by NIA. Our organizations will be meeting jointly on July 21st to discuss all outstanding issues. We are committed to working together to solve these issues in a mutually beneficial manner. As a first step, effective immediately, Peach State has agreed to no longer require “privileging” in order for Obstetricians to perform office based ultrasounds. All obstetricians who have already submitted an application will be automatically considered to have passed the privileging process. If you have not yet returned the application, you are not required to do so. Peach State and the Georgia OB/GYN society will work diligently to come to consensus on the details of the antepartum review program going forward, and we will update you when there are further details for distribution.

Thank you for your forbearance as we work through this process together.

Sincerely,

Peach State Health Plan

This entry is filed under Blog, News.

Dear Peach State Provider:

The Advisory Committee on Immunization Practices (ACIP) now recommends the use of the quadrivalent HPV vaccine, Gardasil, for males, ages 9 to 21 years. Based on the ACIP recommendation and effective immediately, Peach State Health Plan will accept CPT code 90649 for females AND males, ages 9 to 21 years enrolled in the Georgia Medicaid and Peach Care for Kids programs.  

The HPV vaccine will be supplied through the Vaccines for Children Program for males, ages 9 to 18 years, 11 months. The vaccine reimbursement is $8.00 for ages 9 to 18 years, 11 months. Males, ages 19 to 21 will be reimbursed according to the rate contained in your Peach State contract.

Providers should submit claims using the following billing guidelines:

If you have any questions about this communication, please contact Peach State Provider Services at 1-866-874-0633. We will be happy to assist you.

 Thank you.

Peach State Health Plan

This entry is filed under Blog, News.

June 25, 2010

 Dear Provider:

As previously communicated in a letter dated May 12, 2010, Peach State Health Plan (Peach State) has partnered with National Imaging Associates, Inc. (NIA) to implement a radiology benefit management program. This program will focus on enhancing awareness of potentially avoidable high-tech imaging procedures and radiation overexposure among our members. We are committed to implementing programs that ensure coordination of services and provide the highest level of safety and quality for our members.

Thus far, we have made great progress toward the implementation of the new program. To ensure a smooth program launch, we are expanding our transition period and offering additional educational training to the provider community.  Therefore, the start date of the NIA program for Peach State has been revised to August 2, 2010. 

Effective August 2, 2010, prior authorization will be required through NIA for the following non-emergent outpatient radiology procedures:

• CT / CTA
• MRI / MRA
• PET Scan
• OB Ultrasound (The first two ultrasounds will require notification only. The third and subsequent OB Ultrasounds require prior authorization)

Note: Emergency room, observation and inpatient imaging procedures do not require prior authorization through NIA.

We appreciate your continued support and look forward to your assistance in assuring that Peach State members receive clinically appropriate advanced diagnostic imaging services.  Should you have questions at this time, please contact your Provider Relations representative at 866-874-0633.

 Sincerely,

Peach State Health Plan

This entry is filed under Blog, News.

Dear Peach State Provider:

Peach State Health Plan (Peach State) sent a letter to you on March 1, 2010 to let you know about some important changes to our Preferred Drug List. The changes went into effect on April 1, 2010. The changes that were made are described below:

1. Patients will only be allowed to receive one long acting stimulant and two short acting stimulants per month without prior authorization.

We are sending this addendum to the March 1st letter to provide more information about the prescribing of Intuniv. Intuniv is not on the Peach State Preferred Drug List and must be obtained through prior authorization. If approval is granted for Intuniv, it can not be filled in combination with any other long-acting stimulant medication without prior authorization for the dual therapy.

If you have a member who is currently receiving Intuniv in combination with any other long-acting stimulant medication, please consider using either Intuniv or the long-acting stimulant as monotherapy.

If you believe that your patient will require medication therapy outside of the above guidelines, you may submit a prior authorization request to US Script, the pharmacy benefit manager for Peach State Health Plan. The Medication Prior Authorization Request Form is available on the Peach State website, www.pshp.com, under the Provider Forms section. This form can be faxed to US Script at 1-866-399-0929.

Thank you,

Wendy D. Bailey                                               Robyn A. Lorys, Pharm. D.
Director of Pharmacy                                    Director of Clinical Pharmacy
Peach State Health Plan                                Peach State Health Plan

This entry is filed under Blog, News.