PROVIDER REFERRAL GUIDE – SEMINOLE COUNTY

1 1 SEPTEMBER/2020 SEM PROVIDER REFERRAL GUIDE SEMINOLE COUNTY THE FHCP PROVIDER REFERRAL GUIDES CAN BE FOUND AT PROVIDERS AND THE FHCP PROVIDER PORTAL These links make the REFERRAL Guidelines easily accessible and they are updated monthly. The guides are interactive as well NO need to scroll! Helpful Tips when navigating these guides: 1. By typing Ctrl + F it brings up the Find function box. Type the Specialty in the Find box, it will display exact matches to the user. The user should then select the appropriate match they are trying to reference.

2 Once selected, it transports the user directly to the specialty, under the Table of Contents. Click on the Specialty. That will then lead the user to the desired selection. or 2. Go directly to the Specialty of your choice in the Table of Contents and click on the Specialty and it will take you to the specialty section selected. 3. By typing Ctrl + Home will bring the user back to the top of the PDF document. 2 SEPTEMBER/2020 SEM PROVIDER REFERRAL GUIDE SEMINOLE COUNTY CHECK OUT OUR WEBSITE!!! FHCP Central REFERRAL Department 800 /352-9824 (Ext. 3230) Manager / Sue A. Schack, Fax: 855 / 442-8398 Clinical Supervisor / Jane Vesta Community Relations Coordinator / Roberta Hemphill 800 / 352-9824 (Ext.)

3 7423) PROVIDER Relations Coordinator / Carol Cooper 800 / 352-9824 (Ext. 4001) Case Management Utilization Review Department 866 / 676-7187 Case Management Coordination of care Department 855 / 205-7293 PROVIDER Benefit & Eligibility Questions 844 / 615-4024 ** By FHCP Central Referrals Department. For URGENT requests that require pre-authorization, the requesting PROVIDER /staff MUST CALL FHCP s Central Referrals Department at 800 / 352-9824 (Ext. 3230) or 386 / 238-3230. ** Services that require pre-authorization must have documentation as to the medical necessity. If that documentation is not available, the request may be denied.

4 Please refer to the PROVIDER REFERRAL GUIDE for assistance in referring patients for services. Indicates pre-authorization needed 3 SEPTEMBER/2020 SEM FHCP ELECTRONIC REFERRAL PROCESS The Florida Health care Plans (FHCP) Electronic REFERRAL Process is under construction as we are working on building a new platform for authorization submissions. Effective immediately, please fax your requests for Prior Authorization to the FHCP Central REFERRAL Department at 855-442-8398. THANK YOU 4 SEPTEMBER/2020 SEM TABLE OF CONTENTS The Table of Contents listed below outlines Florida Health care Plan s Preferred Participating Providers acute LOW BACK & NECK PROGRAM.

5 9 ALLERGY .. 11 ARTERIAL BLOOD GASES (ABG s) .. 11 AUDIOLOGY/HEARING AIDS .. 12 BARIATRIC SURGERY PROGRAM .. 13 BIRTH CENTER .. 13 BONE DENSITY STUDIES .. 14 BONE SCANS .. 15 BRACES / ORTHOTICS / PROSTHETICS .. 16 BRCA TESTING .. 17 CARDIOLOGY .. 17 CARDIOLOGY - NUCLEAR .. 20 CARDIOLOGY PEDIATRIC .. 21 CARDIAC CATHETERIZATION .. 22 CARDIAC ELECTROPHYSIOLOGY .. 22 CARDIAC MONITORING .. 23 CARDIAC REHABILITATION .. 23 CASE MANAGEMENT COORDINATION OF care DEPARTMENT .. 24 CASE MANAGEMENT UTILIZATION REVIEW DEPARTMENT .. 27 CHIROPRACTIC .. 28 COLOGUARD TESTING .. 28 COLONOSCOPY / SCREENING .. 29 CONTRACEPTION .. 30 CRANIAL REMODELING ORTHOSES.

6 30 CT 31 DERMATOLOGY .. 33 DENTAL SERVICES .. 34 URGENT care .. 34 TMJ SERVICES .. 34 ORAL SLEEP APNEA APPLIANCES .. 34 5 SEPTEMBER/2020 SEM DIABETES EDUCATION .. 35 DIABETIC SHOE PROVIDERS .. 36 DIAGNOSTIC TESTING .. 38 DIALYSIS SERVICES .. 40 DISEASE MANAGEMENT PROGRAMS .. 41 DURABLE MEDICAL EQUIPMENT .. 43 OXYGEN ORDERS .. 43 POV S / ELECTRIC WHEELCHAIR 44 EAR LAVAGE .. 45 EAR, NOSE AND THROAT (ENT) .. 45 EEG TESTING .. 46 EEG TESTING - VIDEO .. 47 ELECTROCARDIOGRAMS (EKG S).. 48 EMERGENCY FACILITIES .. 49 EMG TESTING .. 50 ENDOCRINOLOGY .. 51 EVENT MONITOR .. 52 FEES-FIBEROPTIC ENDOSCOPIC EVALUATION OF SWALLOWING .. 52 GASTROENTEROLOGY.

7 53 GENETIC TESTING/COUNSELING .. 54 GLUCOMETERS .. 55 GYNECOLOGY AND WELL WOMAN S ASSESSMENTS .. 56 HAND THERAPY SERVICES .. 57 HEARING/AUDIOLOGY 58 HEPATITIS C .. 58 HOLTER MONITOR .. 59 HOME HEALTH care .. 59 HOME INFUSION PHARMACIES .. 60 HOSPICE .. 60 HOSPITALS AND EMERGENCY FACILITIES .. 61 acute INPATIENT REHABILITATION FACILITIES .. 62 LTACH ADMISSIONS LONG TERM acute care HOSPTIALS .. 62 HOSPITALISTS .. 63 HYPERBARIC OXYGEN THERAPY (HBO) .. 63 INFECTIOUS DISEASES .. 64 INFUSION SERVICES .. 65 INFUSION SERVICES (INFUSION PUMPS FOR CHEMOTHERAPY) .. 65 INJECTION CLINIC .. 66 INSULIN PUMPS .. 66 6 SEPTEMBER/2020 SEM INTERPRETER SERVICES.

8 68 LABORATORY SERVICES ROUTINE .. 70 LABORATORY SERVICES STAT .. 71 LITHOLINK SERVICES .. 72 LACTATION SERVICES/BREASTFEEDING CLASSES .. 72 LOOP 72 LYMPHEDEMA CLINIC .. 73 LYMPHEDEMA IN-HOME .. 73 MAMMOGRAMS (DIAGNOSTIC OR SCREENING) .. 74 MEDICATIONS .. 75 MOBILE IMAGING 76 MRI S .. 77 NEPHROLOGY .. 79 NEUROLOGY .. 80 NON-EMERGENCY TRANSPORTATION SERVICES .. 81 NUTRITIONAL 82 83 OCULAR PROSTHETICS LAB .. 84 ONCOLOGY 85 ONCOLOGY MEDICAL/HEMATOLOGY THERAPY COMMERCIAL MEMBERS .. 86 ONCOLOGY-MEDICAL/HEMATOLOGY THERAPY MEDICARE MEMBERS .. 86 ONCOLOGY - 87 ONCOLOGY RADIATION THERAPY .. 88 OPHTHALMOLOGY .. 88 OPHTHALMOLOGY-CORNEAL SERVICES ONLY.

9 89 OPHTHALMOLOGY-RETINAL SERVICES ONLY .. 89 OPTOMETRY .. 90 OPTOMETRY LOW VISION .. 90 ORAL SLEEP APNEA APPLIANCES .. 91 ORTHOPAEDICS SPORTS MEDICINE-NON-SURGICAL TREATMENT .. 92 OUTPATIENT REHABILITATION .. 93 HAND 93 PHYSICAL 94 OCCUPATIONAL THERAPY .. 95 SPEECH THERAPY .. 96 VESTIBULAR THERAPY .. 97 VIDEOSTROBOSCOPY AND VOICE THERAPY EVALUATION .. 98 PAIN MEDICINE .. 99 PATHOLOGY OUT- 100 7 SEPTEMBER/2020 SEM PEDIATRICS .. 101 PEDIATRIC SUB-SPECIALTIES .. 101 PEG TUBE FEEDING ASSESSMENT .. 102 PELVIC HEALTH PROGRAM .. 103 PERINATOLOGY .. 104 PET 105 PHARMACY-PREFERRED RETAIL PHARMACY .. 106 PHARMACY-STANDARD RETAIL PHARMACY.

10 107 PHLEBOTOMY SERVICES .. 110 PHYSICAL MEDICINE AND REHABILITATION SERVICES .. 111 PODIATRY .. 112 PRIMARY care .. 113 PROVIDERS OR FACILITIES NOT LISTED IN FHCP DIRECTORIES .. 113 PROVIDER PORTAL REGISTRATION .. 113 PSYCHIATRY/BEHAVIORAL HEALTH .. 114 PSYCHIATRY/BEHAVIORAL HEALTH - OUTPATIENT .. 115 PSYCHIATRY / BEHAVIORAL HEALTH / INPATIENT .. 122 PULMONARY FUNCTION TESTS (PFTs) / SPIROMETRY .. 123 PULMONARY FUNCTION TESTS (PFTs) with DLCO .. 124 PULMONARY REHABILITATION .. 125 PULMONOLOGY .. 126 PULMONOLOGY- PEDIATRIC .. 127 REPORTABLE DISEASES/CONDITIONS .. 128 RHEUMATOLOGY .. 129 SKILLED NURSING FACILITIES .. 130 SLEEP DISORDER 131 SLEEP DISORDER PROVIDER HOME 132 SLEEP DISORDER PROVIDER PEDIATRIC.