Referrals

• Referral form - For HMO referrals to an in-network specialist, or for out-of-network services

Provider directories

• Physician acceptance form - for established members

Commercial groups

• Search for physicians
• Ancillary services
• Complete directory

Medicare

• Search for physicians
• Ancillary services
• Complete directory (Classic, Value, and Employer Group plans)
• Complete directory (Secure plan)

Authorizations

• Authorization list - Procedures that require pre-certification
• Authorization request form
• Pharmacy authorization request form
• Pharmacy authorization criteria
• SNF interdisciplinary nursing report
• Skilled nursing therapy team update

For non-emergent imaging procedures:

• Physician's guide to precertification through American Imaging Management (AIM)
• AIM authorization list - Radiology procedures that require authorization
• AIM precertification request - Fax form
• AIM Q&A - Frequently asked questions about the American Imaging Management/ HFHP diagnostic imaging program

Prescription drugs

• Pharmacy authorization request
• Pharmacy authorization criteria

Commercial groups

• 5-tier commercial group drug list
• 3-tier commercial group drug list

Medicare

• 2010 Value/Classic

• 2010 Group

Claims

Please remember to use the following mailing addresses for new claims:

Health First Health Plans
PO Box 69355
Harrisburg, PA 17106-9355

For information on submitting claims electronically, please visit Claimsnet or call 1-800-356-1511.

Claim dispute form
Corrected claim form modifier 25/59
Provider waiver to initiate Medicare Advantage claim appeal

Changing network status

To ensure a proper continuum of care for our members, it is imperative that we receive a 60-day written notice from any provider office intending to change network status. This includes not accepting new patients, or leaving the network. Your cooperation is greatly appreciated. (Request must be submitted in writing.)

Other

• ID cards - Examples of our member ID cards