Changes to US Family Health Plan’s Authorization Process

This notice is to provide an update on US Family Health Plan’s authorization procedures with our partner Health Integrated. US Family Health Plan strives to offer providers the most efficient and user friendly authorization service; in order to accomplish this, the process for prior authorization request will change effective July 1, 2016.

To achieve more efficient processing of your authorization requests, and to improve turn-around time, we require authorization requests to be faxed using the Service Request Form to the service numbers listed below. To download this form click here.

These Fax numbers should also be used for appeals or lack of information records that are submitted after June 30th. The appeal address also changes after June 30th.

Inpatient – Fax # (844) 580-2721
Outpatient- Fax # (844) 580- 2722

Appeal address:
US Family Health Plan
C/O Health Integrated
10008 N. Dale Mabry Highway
Tampa, FL 33618

Our goal is to make this transition as smooth as possible for all of our providers, and we are here to help. Please do not hesitate to call our Provider Line at (844) 356-4901 if you have any questions. We thank you for being our partner in providing quality care to our military families.

New DME Vendor

We are pleased to announce effective June 16, 2015 USFHP will switch our durable medical equipment vendor from APRIA to Mount Holly Surgical Supply.

Mount Holly is a recognized leader in the development of high quality DME and healthcare products; serving physicians, hospitals, nursing homes and individuals.  For additional information, call us at (844) 356-4901.

Mandatory E-Prescribing – Effective March 27, 2016

  • Beginning March 27, 2016, all prescriptions, including all controlled substances, must be transmitted electronically – paper prescriptions will no longer be acceptable (there are extremely rare exceptions not generally applicable for most dentists).
  • Prescribers will access the Registry through the Health Commerce System (HCS) online account that they already use for renewing and issuing official New York State prescription forms. While many dentists now opt to do those renewals via paper, the only way you will be able to access the Registry is via the HCS online account system.
  • If you fail to sign up for the Registry, you will lose the ability to prescribe any Schedule II, III, or IV controlled substance, as well as the ability to dispense any controlled substance directly to a patient. Your license to practice will also be at risk from the Office of Professional Discipline (OPD) if you attempt to evade or violate the Registry system.
  • For further information on the HCS online account system, go to: https://hcsteamwork1.health.state.ny.us/pub/top.html or call the HCS account system at either: (866) 529-1890, option 1; or (866) 811-7957, option 1
  • FAQ Link: http://www.op.nysed.gov/prof/pharm/pharmelectrans.htm

CMS Update

Effective 01/01/14, only G0463 will be recognized as the appropriate code for an outpatient hospital clinic visit.  We have been applying the CN1 denial message (CODE NOT RECOGNIZED BY OPPS, BILL ALTERNATE CODE) to these when OPPS generates this error.