Information for Providers
Provider Manual
Note: All files are in Adobe Acrobat PDF Format
- Welcome & Overview of the USFHP
- Table of Contents
- Chapter 1. Introduction to Plan Chapter
- Chapter 2. Important Numbers & Addresses
- Chapter 3. Provider Rights & Responsibilities
- Chapter 4. Membership & Eligibility
- Chapter 5. Plan Procedures
- Chapter 6. Covered & Non-Covered Services
- Chapter 6b. Copayment Chart
- Chapter 6c. Services Not Covered
- Chapter 7. Preventative Health Guidelines
- Chapter 8. Pharmacy Services
- Chapter 8a. Pharmacy Non-Preferred Drug Request Form
- Chapter 8b. Pharmy Request for Preferred Drug List Addition Form
- Chapter 9. Claims & Encounter Data
- Chapter 10. Reimbursement Methodologies
- Chapter 11. Emergency Services
- Chapter 12. Referral Guidelines
- Chapter 13. Clinical Quality Management
- Chapter 14. Utilization Management
- Chapter 15. Integrity
- Glossary
Memorandums
Tips / Important Reminders
Newsletters
- 2007
» January-March
» April-June
» July-September
» October-December - 2006
» January-March
» April-June (Not Available)
» July-September
» October-December - 2005
» January-March
» April-June
» July-September
» October-December
Referral and Authorization Process
- Process Summary for Providers
- Process Summary for Facilities
- Instructions for Completing Authorization/Referral Form
- Authorization/Referral Form (Front)
- Authorization/Referral Form (Back)
- Authorization Grid
- DME Authorization List
- Splints, Braces and Orthotic Devices List
- Drugs Requiring Authorization
Preferred Drug Lists (Formulary)
Pharmacy Numbers and Addresses
MAXOR Pharmacies
USFHP Maxor Mail-Order Pharmacy
Provider Rosters / Directories
- Provider Roster
- Provider Monthly Updates
- Change Requests (Update your Information)
- Unless a W9 form
Provider Nominations (other physicians they would recommend)
Electronic Claims Filing
- Request Form
- Instructions
- Important Reminders
- Electronic Manual
