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

Posted in Blog, News | No Comments »

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

Posted in Blog, News | No Comments »

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

Posted in Blog, News | No Comments »

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 »

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

Posted in 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 | 1 Comment »

Please click the link below to review the Provider Watch.

Provider Watch – Pharmacy Bulletin – Important Updates (PDF)

Posted in Blog, Media, News | No Comments »