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Provider Update  Spring 2016Top
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Dear Providers,

We recently updated our US Family Health Plan Provider Manual. This document provides you with an outline of the requirements of participating providers. You can download the manual or read it online here.
If you have any questions about the manual or about accessing it, please contact me at billy.partain@usfamilyhealth.org or by telephone at 617.562.5548. We have mailed a letter to all providers notifying them of the revision of the manual.

Please note that Stephanie will be on maternity leave from the end of May until the middle of August. I will be covering for her.

Once again, thank you for the excellent care you provide for our US Family Health Plan members.
Sincerely,
 
Billy Partain, RN
Manager, Provider Relations and Contracting
Meet Our Provider Reps
 
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Paper Claim SubmissionReadMoreArticle1

US Family Health Plan encourages electronic claim submission, but we also accept paper claim submissions. Paper claims must be submitted on official, standard red claim forms. Black-and-white versions, including photocopied versions, will not be accepted and will be returned to the address listed in Box 33 (on CMS-1500 forms) or Box 1 (on UB-04 forms).

Please also note that the member ID number on the claim must match the member ID number in the US Family Health Plan system. The claim will be rejected if there is not an exact match. Claims will also be rejected if the member's Social Security number is used instead of the member's US Family Health Plan ID number.
 

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Exclusivity ReminderReadMoreArticle2

As an exclusive provider in the US Family Health Plan network, you are part of the premier military health plan dedicated to the highest degree of service and clinical quality. US Family Health Plan is a civilian-based option of TRICARE headquartered locally in Boston and supported by our third-party administrator, Tufts Health Plan.

It has been brought to our attention that some US Family Health Plan providers have been approached by HealthNet Federal Services, the contractor for the other TRICARE benefit options in this region.

Providers are reminded that participation in US Family Health Plan's premier network is exclusive. US Family Health Plan participating providers who join this exclusive network have agreed not to participate in competing TRICARE programs.

If you have questions about the exclusivity requirements or would like to learn more about why we are the premier military option for both members and providers, please contact Billy or Stephanie.
 

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News About Ordering Durable Medical EquipmentReadMoreArticle3

US Family Health Plan now allows all providers to order Durable Medical Equipment (DME). In the past, only MDs and DOs were allowed to order DME. Now all TRICARE authorized providers, including podiatrists, nurse practitioners, and physician assistants, may order DME.

When ordering DME, please be aware that US Family Health Plan primarily follows Medicare guidelines for medical necessity. This may require a face-to-face evaluation for some DME. Please submit either the Medicare DME authorization forms or the Tufts Health Plan forms when ordering DME.

TRICARE requires US Family Health Plan providers to submit a consult note to the referring clinician within seven business days of the initial visit with the member. This requirement is designed to improve communication between the referring clinician and the specialty provider and to facilitate coordination of the member's care. The quality of care and member satisfaction are greatly improved when communication between the consulting provider and the referring physician is formalized through a written document in the patient record. Please help the Plan comply with this requirement.


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Provider Relations Team
Billy Partain Photo  
Stephanie Shapiro Photo OurReps 
Billy Partain
Provider Relations and
Contracting Manager
Stephanie Shapiro
Provider Relations
Representative
email 
617.562.5548 (office)
617.992.1882 (cell)

All of Massachusetts except Cape Cod
and the south coast.
email
617.562.5254 (office)
617.992.1883 (cell)

All of Rhode Island, Saint Anne's Hospital, Cape Cod Hospital, and Falmouth Hospital.