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

Posted in Blog, News | No Comments »

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

Posted in Blog, News | No Comments »

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

Posted in Blog, News | No Comments »

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/

Posted in Blog, News | No Comments »

Dear Peach State Provider:

Peach State Health Plan is making some important changes to our Preferred Drug List, beginning June 14, 2010.  The changes that will be made are described below:

1. Drugs used for the symptomatic relief of cough and colds will only be covered 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 in 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

Posted in Blog, News | 2 Comments »

Please click the link below to review the Provider Watch.

Provider Watch – Pharmacy Bulletin – Important Updates (PDF)

Posted in Blog, Media, News | No Comments »

Please click the link below to read the blast fax from the American Academy of Pediatrics – Georgia Chapter.

Flu Vaccine Survey (PDF)

Posted in Blog | Comments Off

Please click the link below to read the blast fax from the American Academy of Pediatrics -Georgia Chapter.

Recommendation to Temporarily suspend usage of Rotarix Vaccine (PDF)

Posted in Blog | No Comments »

Dear Peach State Provider:

Peach State Health Plan (Peach State) is making some important changes to our Preferred Drug List, beginning April 1, 2010. The changes that will be 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.
2. The refill threshold for controlled substances, such as narcotic analgesics, benzodiazepines, stimulants, and amphetamines, will be changed from 85% to 90%.

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

Posted in Blog, News | No Comments »

Great News!! Peach State  is proud to  announce a new web enhancement to the Provider Secure Portal.  An Office Manager function has been added. This role allows a user who is designated as the Office Manager during the Secure Portal registration process to manage the other users associated with the Provider’s Tax Id Number.

The user designated as the Office Manager will have the ability to create new user logins, disable user logins, and reset passwords for other office staff associated with the same TIN. At least one user for the provider site should be designated as Office Manager. 

Provider offices that have not previously designated an Office Manager during the registration process must create one by registering at www.PSHP.com. During the  registration process, please select the Office Manager Role.

Provider offices in which multiple users have been designated as the Office Manager during registration, we recommend that you review the users registered for your TIN and adjust the roles of any user flagged incorrectly as Office Manager.

Peach State will be offering Webinar sessions to demonstrate the functions available with this new Office Manager Role.  The webinar sessions will be offered March 8, 2010 through March 12, 2010 at 12:00 PM and 2:00 PM.  Please register for these sessions by accessing https:centene.webex.com. Click on the Meeting Center tab and then Browse the Meetings available on the Monthly tab to register for one of the Peach State Secure Portal Office Manager Training sessions.

Posted in Blog, News | No Comments »