Peach State Health Plan Blog

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.

Dear Peach State Member,

 On April 30, 2010 there was a recall on some over-the-counter (OTC) medicines. The recalled OTC medicine is for Children and Infants. They are being recalled because some of them may not meet certain standards.

 There was a meeting on May 4, 2010 to review the recall letter. The letter stated: 

• Some of the products may have a higher level of an active ingredient.
• Some of the products may have inactive ingredients that may not meet testing guidelines.
• Others may have tiny pieces that do not belong.
• There is not a great possibility for serious illness or injury. 
• STOP using the medicine and throw it out[1]. 

The recall is not in response to a serious illness. But we want to prevent a serious illness.  Parents and caregivers should NOT give these products to their children.  Click here for a list of the recalled products. 

If you have any questions please call the Member Services Department at (800) 704-1484. If you are hearing impaired call (800) 659-7487. 

Sincerely, 

Peach State Health Plan

This entry is filed under News.

May 14, 2010

Dear Peach State Provider:

Peach State Health Plan (Peach State) is making some important changes to our Preferred Drug List.  The changes that will be made are described below:

1. Beginning July 1, 2010, Atypical antipsychotic prescriptions will be subject to age limits based on manufacturer and FDA labeling. Physicians must obtain prior authorization in order for patients below the FDA approved age limit to receive the requested atypical antipsychotic drug.
2. Beginning June 14, 2010, Drugs used for the symptomatic relief of cough and colds will be covered only for members under age 21.

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 Blog, News.

Effective July 12, 2010, Peach State will be implementing a new outpatient imaging program for select diagnostic imaging procedures. This program includes the management of non-emergent, advanced outpatient radiology services to include prior authorization.

 Peach State and NIA welcome you to attend one of our upcoming Provider Education Webinars to learn more about NIA’s outpatient imaging program and what it means to you. Hour-long Provider Education Webinars will take place on the following dates:

• Thursday, June 10^th
• Tuesday, June 15^th
• Wednesday, June 16^th
• Thursday, June 24^th
• Friday, June 25^th
• Monday, June 28^th
• Thursday, July 8th

 
Webinar sessions will be held at 12:00 p.m. each day. You will need a computer with Internet access to view the education materials presented during the Webinar.

Please RSVP at least 1 week prior to the education seminar you plan to attend by calling an NIA representative at (800) 327-0641. After your RSVP, you will receive a confirmation email from NIA for the Webinar session you selected. The confirmation email will also include a toll-free dial in number with access code and web meeting address.

Peach State and NIA look forward to working with you to ensure that your Peach State patients receive diagnostic imaging services delivered in a quality, clinically appropriate fashion.

  NIA’s website: http://www1.radmd.com/

This entry is filed under Blog, News.