Peach State’s new Interactive Voice Response system will give providers and members additional automation and self service functionality. New features of the system include:   

1. Full speech recognition 
2. Member eligibility verification
3. Member PCP name and telephone number 
4. Member co-pay information  
5. Claims status lookup

For more information about our new enhancements to the IVR, ask to speak with a Representative today!

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Dear Peach State Providers,

We are pleased to share an educational opportunity with you regarding PaySpan Health (Payformance). Payformance is happy to announce the continuation of the Webinar Wednesday program. Listed below are scheduled webinar dates for February 2011. Due to limited space, early registration is encouraged.

  During the webinar, the following topics will be covered:

o        Viewing News & Alerts

o        Working with New Payments

o        Using the New Posting & Denial Reports

o        How to Use Account & Payer Management

o        Search for Remits using Document Archive Search

o        User Administration

o        Mailbox Management

o        Questions & Answers

Sign up for a FREE PaySpan Health Training Webinar today! Please click one of the links below to register for the meeting of your choice. Space is limited!

Please click one of the links below to register for the meeting of your choice.

Space is limited! 

***PLEASE NOTE ALL WEBINAR TIMES ARE EASTERN TIME***

*** PaySpan Health Website Training *** 

Wednesday, February 16, 2011 – 2:00PM EASTERN STANDARD TIME

https://www2.gotomeeting.com/register/541179770

During the webinar, the following topics will be covered:

• Viewing News & Alerts
• Working with New Payments
• Using the New Posting & Denial Reports
• How to Use Account & Payer Management
• Search for Remits using Document Archive Search
• User Administration
• Mailbox Management
• Questions & Answers

*** PaySpan Health Mailbox Training ***

Wednesday, February 9, 2011 – 10:00AM EASTERN STANDARD TIME 
https://www2.gotomeeting.com/register/766959187

During the webinar, the following topics will be covered:

• Define the PaySpan Health Mailbox
• Discuss Access Points
• Demonstrate Setup of Mailbox
• Routing Files to Data Exchange Partner
• Questions & Answers

You may be eligible to register additional payers to your PaySpan® Health account. Reply to this email if you are interested in receiving more payments and remittances electronically.

Click here or copy and paste this link into your browser window to view a list of all PaySpan Health Payers:

http://www.payformance.com/for-providers/participating-health-plans/

To speak with one of our Provider Services Specialists, please call 1-877-331-7154. The Provider Services Team is available Monday through Friday, from 7am to 9pm Eastern Time.

Thank you for using PaySpan® Health.

Provider Services

PaySpan® Health

1-877-331-7154

providersupport@payspanhealth.com

www.payspanhealth.com

PaySpan® Health -

“The Electronic Settlement Network. The right choice for real savings and provider satisfaction.”

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Dear Peach State Provider:

Please click the link below to review the Family Planning PDL.  For questions or concerns, contact your Provider Relations specialist or call 1-866-874-0633, Monday – Friday, 7am – 7pm.

Family Planning Preferred Drug List

Thank you~

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January 24, 2011

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, 2011, the changes described below will be made.

1. Patients receiving a new prescription for an aromatase inhibitor will be required to try generic Anastrozole prior to taking a branded drug in the same class (Femara or Aromasin). Patients already on therapy with a branded aromatase inhibitor will be allowed to remain on the current therapy, but will be required to try Anastrozole if a change in medication is needed.

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

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                                                                                                                            MEDIA CONTACT

                                                                                                                                                                                         Robert Clarke

                  (404) 446-1670

rclarke@duffey.com

FOR IMMEDIATE RELEASE                                           

PEACH STATE HEALTH PLAN PARTNERS WITH

MEMORIAL UNIVERSITY MEDICAL CENTER

FOR INFORMATIVE TEEN PREGNANCY PREVENTION SYMPOSIUM

 ATLANTA, GA (January 19, 2011) — On Dec. 3, Peach State Health Plan^™ (Peach State), in partnership with Memorial University Medical Center in Savannah, GA., hosted a symposium and panel discussion on teen pregnancy prevention. Headlined by Michele Ozumba – President and CEO of the Georgia Campaign for Adolescent Pregnancy Prevention – the symposium and panel covered a wide range of topics around teen pregnancy including sex education for teens, unplanned pregnancy, teen drug use during pregnancy and abused teens.

“Adolescent pregnancy is a serious problem in the United States, and Georgia has one of the highest rates of teen pregnancy in the country,” says Patrick Healy, president and CEO of Peach State. “It is critical that we address this problem head on and provide our youth with the knowledge to make appropriate decisions.”

Peach State awarded two 2010 Excellence in Teen Pregnancy Prevention Awards to Pamela Gallup, MD and the Chatham County Board of Health in recognition for their efforts in teen pregnancy prevention outreach and education. According to Georgia Campaign for Adolescent Pregnancy Prevention, Georgia has the eighth highest teen birth rate in the nation. Over 22,500 teen pregnancies occur each year in Georgia. That amount equals 62 new teen pregnancies each day – or more than two teen pregnancies an hour. In addition, adolescent pregnancy prevention is an effective poverty reduction strategy.

 “It is important to remember that the poverty rate for children to teen mothers who have never married and have not graduated from high school is 78 percent in Georgia,” says J. Dean Greeson, MD, VP, Medical Affairs for Peach State. “Adolescent pregnancy is an issue that affects everyone in the state of Georgia, and we are trying to help solve the problem in whatever way we can.”

Peach State distributed copies of the award winning teen book, “Off the Chain” during the ceremony to the attendees and participants. The book’s author, Michelle Bain wrote the book in efforts to answer many of the questions teens have about life’s important issues.

 About Peach State Health Plan

Peach State Health Plan (Peach State) is a Care Management Organization that serves the Medicaid and PeachCare for Kids ^™ population in partnership with Georgia Families. Peach State is a wholly owned subsidiary of Centene Corporation, a leading multi-line healthcare enterprise offering both core Medicaid and specialty services. Information regarding Peach State is available via the Internet at www.pshp.com.

About Centene Corporation

Centene Corporation, a Fortune 500 company, is a leading multi-line healthcare enterprise that provides programs and related services to the rising number of under-insured and uninsured individuals. Many receive benefits provided under Medicaid, including the Children’s Health Insurance Program (CHIP), as well as Aged, Blind or Disabled (ABD), Foster Care and long-term care, in addition to other state-sponsored programs, and Medicare (Special Needs Plans). Centene’s CeltiCare subsidiary offers states unique “exchange-based” and other cost-effective coverage solutions for low-income populations. The Company operates local health plans and offers a range of health insurance solutions. It also contracts with other healthcare and commercial organizations to provide specialty services including behavioral health, life and health management, managed vision, telehealth services, and pharmacy benefits management. More information regarding Centene is available at www.centene.com. 

### 

Quality Symposium _ Teen Pregnancy Prevention News Release.doc

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Dear Provider,

In an effort to better serve our members, Peach State Health Plan™ (Peach State) is making updates to the Prior Authorization Process for Specialty medications. Please review the new procedure, as we feel it will streamline the process in your office and here at the plan. This change will be effective on 01/17/2011.

In the past, we have asked providers to send requests for medications provided by Caremark directly to Caremark for processing and to send requests for medications provided out of office stock directly to Peach State’s Pharmacy Department.

Although Caremark will continue to be Peach State’s preferred Specialty Pharmacy vendor and will ship medication to our members, prior authorization requests should no longer be sent to Caremark for review. All requests for specialty medications supplied by Caremark, and out of office stock, should be sent directly to Peach State’s Pharmacy Department. We expect that having one fax number for all specialty medication requests will simplify the prior authorization process. The attached prior authorization form has been created for your convenience. It contains most of the information we need for processing a medication request, as well as the Peach State’s Pharmacy Department phone and fax number. Be sure to indicate in the top section of the prior authorization form whether your request is for a product that will be shipped by Caremark or for a product that will be dispensed out of your Office Stock.

It is very important to remember that prior authorization forms do not include all the information needed for a proper review. You must send in clinical documentation that supports the diagnosis and use of the requested medication (for example; labs, chart notes, radiology reports, etc…)

US Script will continue to receive and process all retail pharmacy prior authorization requests. Retail Pharmacy medications would include oral or topical preparations that are self-administered and available at most local pharmacies. Those requests should be sent to US Script using the appropriate form and fax number found on our website.

We expect that this new process will be more convenient for you as there are now only two options, retail pharmacy/US Script or specialty medication/Peach State. If you have any questions that arise while preparing or processing a request, please call the Peach State Pharmacy Department at 800-514-0073 option 2.

Thank you,

Wendy Bailey, R.Ph and Robyn Lorys, Pharm. D.

Peach State’s Pharmacy Department

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Dear Provider:

Please select the link below to review the Provider Communication Tip Sheet. This resource tool has been developed to provide  updates regarding Peach State’s programs and services. For questions or concerns, call the Provider Solutions Department, 1-866-874-0633, Monday – Friday, 7 am-7 pm.

Provider Communication Tip Sheet

Thank you~

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Dear Provider:

Attached is the latest information regarding enhancements to Peach State’s website. Please select the link below to read this issue. For questions, contact Peach State’s Provider Department at 866-874-0633, Monday-Friday, 7am-7pm.

Provider Watch – December 2010

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Dear Provider:

The 2010-2011 Flu Season is underway and the CDC (Centers for Disease Control and Prevention) recommends that everyone, 6 months or older receive an “annual influenza vaccination”.

As you already know, the flu (influenza) is an infection of the nose, throat, and lungs caused by the influenza viruses. The flu vaccine is the best way to protect against the flu. Please encourage your Peach State patients to obtain a flu shot regardless of their age; including your pregnant members, since pregnancy can increase the severity of the flu. According to the CDC, this year’s seasonal flu vaccine includes protection from the 2009 H1N1 virus, and two other influenza viruses (an H3N2 virus an influenza B virus).  

To ensure accurate and timely claims processing, please adhere to the benefits and billing requirements provided in this notification.  

 Providers should report these services using one of the following CPT codes.

90655- Influenza virus vaccine, children 6-35 months (preservative free); intramuscular

90656- Influenza virus vaccine, individuals 3 years and above (preservative free); intramuscular

90657- Influenza virus vaccine, children 6-35 months; intramuscular

90658- Influenza virus vaccine, individuals 3 years and above; intramuscular

90660- Influenza virus vaccine, (FluMist); intranasally

Diagnosis Code: V04.81

Note: Providers who receive their vaccine through Vaccines for Children (VFC) will be reimbursed for the administration fee only.

We are pleased to offer expanded coverage to all eligible adult Peach State members (ages 18 and over) to receive the flu shot at either their physician’s office or select participating pharmacies. Members must be at least 18 years old to receive their flu shot at the pharmacy and must present a valid prescription for the flu shot to the pharmacist. Members who are under 18 years of age must receive their flu shot from their doctor’s office. To locate a local participating pharmacy, please refer to the attached participating pharmacy list.

Peach State wants our members to stay healthy during this flu season! Please encourage all members to get their Flu Shot Today! If you have questions or need more information, please contact Peach State Provider Services at 1-866-874-0633.

Sincerely,

Peach State Health Plan

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Dear Peach State Provider:

Recently you received an invitation from Peach State Health Plan (Peach State) to attend our town hall meeting in Columbus at the Columbus Convention and Trade Center on Tuesday, December 7, 2010.  The goals of the meeting were to give providers and other interested stakeholders an operations update on calendar year 2010 activities, discuss new initiatives planned for 2011, and establish a forum for dialogue with our senior leadership team.

Following our invitation outreach efforts, we have found that most of our providers have indicated that they are satisfied with the current means for receiving updates and engaging in dialogue with Peach State.  For this reason, we have decided to postpone this town hall meeting and work towards putting together another event in early first quarter of 2011. Please accept our apology if this comes as an inconvenience. Thank you for your understanding and for the excellent care you provide to our members. 

Should you have questions or need assistance, please contact us at 1-866-874-0633.  

Sincerely,

Kevin Sears

Vice President of Provider Affairs

Peach State Health Plan

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