Peach State Health Plan Blog

January 20, 2010

Dear Peach State Provider:

Peach State Health Plan (Peach State) is making some important changes to our Preferred Drug List, and we are writing to communicate the changes to you. Beginning March 1, 2010, the changes described below will be made.

1. Patients receiving a new prescription for an atypical antipsychotic will be required to try generic risperidone prior to taking a branded drug in the same class. Patients already on therapy with a branded atypical antipsychotic will be allowed to remain on the current therapy, but will be required to try risperidone if a change in medication is needed.
2. Focalin and Focalin XR will no longer be preferred drugs on the Peach State Preferred Drug List. Patients already receiving Focalin and/or Focalin XR will be allowed to remain on the current therapy, but all new starts with Focalin or Focalin XR will require prior authorization.

If you, as a physician, feel that a patient will require medication therapy outside of the above guidelines, you can 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, RPh.                   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 News.

Our eligibility and claims systems will be unavailable on Saturday, Dec. 19 for scheduled maintenance. Please try back later to complete your transaction. Thank you.

This entry is filed under News.

An Electronic Health Record (EHR) is a computerized medical record. It typically contains all of the information stored in a paper medical record – progress reports, diagnoses, prescription records, treatment histories, X-rays, and the like – though it may be limited to a subset of a paper medical record. The most commonly cited advantage of adopting EHRs is the tremendous amount of space saved. Instead of keeping huge paper files on all patients, records are kept on computer files, thus limiting the amount of physical space needed to store files. However, this is only one of a myriad of benefits to using EHR.

One significant advantage of using EHRs is the ability for all members of the health care team to coordinate care. This helps decrease the number of duplicate tests and reduces potential drug interactions. Patients with complex health issues may see numerous specialists and may receive overlapping or – even worse – contrary advice. When all treating physicians utilize the same system for electronic records, the entire health care team is able to see all the other providers’ actions and recommendations and better collaborate in the patient’s care.

In addition to saved space and coordination of care, other advantages to EHRs include:

• Saves time:  EHRs offer instantaneous access to records; no more faxing and emailing requests and waiting for responses.
• Ease of understanding:  no more deciphering illegible handwritten chart notes.
• Improved health care quality and safety.
• Increased clinical and administrative efficiency.
• Better communication between patients and physicians.

Look for additional information regarding EHRs in your upcoming provider newsletter.

This entry is filed under Blog.

Requests for Hospital Statistical Reports (HS&R)

Dear Georgia Hospital Provider:

Peach State Health Plan (Peach State) is pleased to announce a new and more efficient process for responding to your requests for HS&R reports. The new process allows Peach State to track report request through a single entry point and increase the turnaround time for production and delivery of your reports. We will also provide you with an acknowledgement notice that confirms the receipt and processing of your request.

Effective immediately, you must adhere to the process outlined below when requesting HS&R reports. 

• All requests for production of HS&R reports must be submitted via e-mail to the designated e-mail box or via certified mail to the address identified below.
• Please note: Any request submitted directly to an individual’s attention will be returned to the requestor via email with instructions on how to submit the request via one of the methods identified below.
• Acknowledgement notices will be provided via email within three (3) calendars days of receipt of your email request.
• Acknowledgement notices will be provided in writing within five (5) calendar days of your written request.
• Submit your e-mail request to:   
  • HSRRequest@pshp.com
  • SUBJECT: Request for HS&R Report

Submit your written request via Certified mail to:

Peach State Health Plan
VP of Compliance
3200 Highlands Parkway SE
Suite 300
Smyrna, GA 30082
ATTN:  Request for HS&R Report

Reminder: 

In order to generate your reports, you must provide the following information:    

a. Hospital Name
b. Hospital Tax ID Number
c. Provider Medicaid ID Number
d. Hospital fiscal year or period service dates
e. Hospital fiscal year or period for paid through dates
f. Contact Information – including email

This entry is filed under Blog, News.

The American Medical Association (AMA) web site offers up to date and practical information for helping patients during the 2009-2010  seasonal flu season and clinical guidelines to manage the 2009 H1N1 influenza virus.  Please review the link below to access the latest developments and information regarding H1N1 influenza virus.

AMA web site

This entry is filed under Blog, News.