USFHP

Provider Information

USFHP has the following resources for providers:

		Important Pharmacy Information

		Important Utilization Updates Benefit Update 9.14.12 Benefit Update 6.29.12 Benefit Update 7.18.12
		Important Information for Healthcare Providers Provider Input and suggestions Non-credentialed Healthcare Provider Specialties Provider Demographic Change Form

		US Family Health Plan Benefits To find out whether a healthcare service is a covered US Family Health Plan benefit, click here.

		Provider Manual Provider Manual

		Provider Newsletter Provider Chronicle, Spring 2013 Provider Chronicle, Fall 2012 Provider Chronicle, Summer 2012

		Member Eligibility / Claim Status To check Member Eligibility, Claims Status or Authorization Status (via the internet using E Power) click here, or via our Fax Recall System by dialing 212-868-9447.

		Provider Quick Reference Guide To print the Provider Quick Reference Guide (PDF document), click here.

		Outpatient Referral Form click here to print out the Outpatient Referral Form. Fill out the form, leaving the Form Number box blank. Make 1 copy. Give the original to the patient, and keep the copy for the office records.
		Utilization Management Contact our utilization review department at 866-390-0933 (phone) or 866-813-1722 (fax) to precertify ALL services except outpatient PT and OT.

		Behavioral Healthcare Contact Health Integrated to pre-certify services, or to obtain a listing of behavioral health providers at 866-390-0933. For more information on Health Integrated visit their website at www.healthintegrated.com

		Apria Contact Apria at 800-294-2275 for most non-customized DME, ambulatory assistive devices, home oxygen and home respiratory equipment.

		Labcorp All lab work should be referred to Labcorp with the exception of In-office Stat Procedures. For a listing of allowed In-office Stat Lab Procedures, click here. To obtain a listing of Labcorp Patient Sevice Centers contact Labcorp at 800-788-9091, or visit the Labcorp web site at www.labcorp.com.

		Physical Therapy/ Occupational Therapy To precertify outpatient PT/OT services contact Orthonet at 800-401-0062. For more information on Orthonet, visit their website at www.orthonet-online.com.

		Pharmacy To download information on pre-authorization requirements, click here. To download information on Categories of Prescription Drugs with Quantity Limits, click here. To down load a list of injectables, which require pre-authorization and are available from Maxor Mail Order, click here. To download information on Tier 3 (Non-formulary brand name medications), click here. To download information on TRICARE Uniform Formulary exclusions, click here. To download the Brand Name Request form (providers only), click here. To download the Quantity Override Request form (providers only), click here. For additional pharmacy information, contact Maxor Plus at 800-687-0707 or visit their web site at www.maxor.com.

		Claims and Billing Information Submit Medical Claims Electronically via WebMD, Payor ID 13407. Use ONLY updated or current diagnosis and procedure codes. USFHP members cannot be balanced billed for any amounts in excess of the allowed amount, other than for copayments and coinsurance. USFHP is always primary to Medicare with few exceptions. Do not bill Medicare or Medicaid. Claims status can be checked online by accessing the Provider Portal by clicking here or by dialing 212-868-9447 and accessing our Fax Recall system. Medical Claims Address: US Family Health Plan at SVCMC PO Box 830745 Birmingham, AL 35283-0745