Peach State Health Plan Blog

Respiratory Syncytial Virus (RSV) Season

August 1, 2009

Dear Peach State Health Plan Clinician,

Please find the Peach State Health Plan (Peach State) Synagis^® Authorization Guidelines for the 2009-2010 RSV season below.  These guidelines were developed based on recommendations of the American Academy of Pediatrics (AAP) and local Georgia physicians.

The following modifications have been made to the AAP guidelines for infants born between 32 weeks, 0 days through 34 weeks, 6 days:

• Must be younger than 3 months of age at the start of the RSV season or born during the RSV season, and
• Must either attend child care or have a sibling younger than 5 years of age.
• Synagis should only be given until the infant reaches 3 months of age.

Peach State will again use Caremark as its preferred provider of Synagis for the 2009-2010 RSV season. Beginning immediately, all requests for Synagis should be forwarded to Caremark for initial screening to determine if the request meets criteria for coverage. A copy of the Caremark RSV enrollment form is enclosed. When submitting the enrollment form, please attach the NICU discharge summary to expedite the review process. 

Caremark will be responsible for the delivery of the injectable product and the overall coordination of the drug distribution process. All injectable products will be billed directly to Peach State by Caremark and shipped to your office. Administration charges for the injection should be billed directly to PSHP on a (HCFA) CMS 1500 claim form using CPT code 96372. You can also bill for an appropriate office visit for each administration of the drug. 

Caremark specializes in specialty injectables and can provide the support and follow-up with ATC members to ensure compliance and positive clinical outcomes. Caremark offers:

• 24-hour access to the Caremark case management team
• Patient education and compliance monitoring programs
• Direct refill and renewal coordination
• Approved clinical protocols and treatment guidelines
• Synagis approval for the entire RSV season

For RSV enrollment, please call 1-800-237-2767, or fax a completed Caremark RSV enrollment form prior authorization request form to 1-800-323-2445.  For additional questions, contact the Peach State Pharmacy Department at 1-800-514-0083 option 2. 

Thank you for your cooperation,

Dean Greeson, M.D.

Vice President, Medical Affairs

Synagis Authorization Guidelines

Caremark RSV Enrollment Form

Peach State Health Plan Synagis Administration Policy

This entry is filed under News.

Please select the attachment below to review the ClaimXsten Guide. This guide was emailed to your practice, August 28, 2009.  If you need assistance, please call our Provider Solutions Department at 1-866-874-0633, Monday – Friday, 7am-7pm.

New Billing Requirements – ClaimXsten Guide (PDF)

This entry is filed under News.

Don’t let the flu get you!

What is the flu?

The flu (influenza) is an infection of the nose, throat, and lungs caused by influenza viruses. Every year, seasonal flu viruses cause illness, hospital stays and deaths in the United States.  There are many different flu viruses and sometimes a new flu virus emerges to make people sick.

What is H1N1 flu?

H1N1 flu (or “swine flu”) is a new and very different influenza virus that is spreading worldwide among people.

 This fall and winter, the new virus may cause a lot more people to get sick than during a regular flu season. It also may cause more hospital stays and deaths than seasonal flu.

 What are the symptoms of the flu?

Symptoms of seasonal flu and H1N1 flu include

• Fever
• Cough
• Sore throat
• Runny or stuffy nose
• Body aches
• Headache
• Chills
• Fatigue

Some people also may have vomiting and diarrhea.

 How do you protect yourself from the flu?

It’s as easy as 1 – 2 – 3!

 1)  Get your seasonal flu vaccine. This can be either be a shot or nasal spray depending upon your age and health.

2) Get your H1N1 vaccine once it becomes available.  People at higher risk for H1N1 flu include:

• Pregnant women
• Anyone six months to 24 years old
• Caregivers of infants younger than six months of age
• Adults under 65 with other health conditions such as diabetes or asthma
• Healthcare workers

3) Take everyday steps to prevent the spread of germs!

• Wash your hands often, especially after you cough or sneeze. Wash for at least 20 seconds with soap and water.
• Avoid touching your eyes, nose or mouth.
• Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
• Avoid close contact with people who are sick as much as possible.
• If you get the flu, stay home.  Try not to spread the illness to others.

 For more information, please call us at [1-800-704-1484] or visit our website at Peach State Health Plan. You can also visit www.flu.gov.

Remember to follow your doctor’s advice. If you have any questions, call your doctor.

Be a Bug Stopper! Avoid the flu with FLUVENTION!

Source: www.flu.gov

This entry is filed under Blog.

Dear Provider:

Peach State Health Plan (Peach State) has partnered with PaySpan Health to offer you expanded claim payment services. By signing up with PaySpan Health, a web-based application, you will receive convenient electronic claim payments (EFTs), and online remittance advices (ERAs/EOPs). These services assist practices in receiving claims payments quicker. Peach State is offering this service immediately to our providers upon your enrollment with PaySpan Health. Don’t delay, enroll today; call PaySpan Health at 1-877- 331-7154 or register at www.payspanhealth.com.

• Elimination of paper checks – all deposits transmitted via EFT to the designated bank account
• Convenient Payments & Retrieval of remittance information
• Electronic remittance advices presented online
• HIPAA 835 electronic remittance files for download directly to a HIPAA – Compliant Practice Management or Patient Accounting System 
• Reduce accounting expenses – Electronic remittance advices can be imported directly into practice management or patient accounting systems, eliminating the need for manual re-keying 
• Improve cash flow – Electronic payments can mean faster payments, leading to improvements in cash flow
• Maintain control over bank accounts – You keep TOTAL control over the destination of claim payment funds. Multiple practices and accounts are supported
• Match payments to advices quickly – You can associate electronic payments with electronic remittance advices quickly and easily
• Manage multiple Payers – Reuse enrollment information to connect with multiple Payers Assign different Payers to different bank accounts, as desired

 Peach State Health Plan

This entry is filed under News.

Medicaid and Children’s Health Insurance Program (CHIP) – Coverage of HIV testing and HIV screening (PDF)

This entry is filed under Blog.