PROVIDER REFERRAL GUIDE – VOLUSIA/FLAGLER COUNTIES

1 1 volusia & flagler COUNTIES MAY 2022 PROVIDER REFERRAL GUIDE VOLUSIA/FLAGLER COUNTIES THE FHCP PROVIDER REFERRAL GUIDES CAN BE FOUND AT AND THE FHCP PROVIDER PORTAL These links make the REFERRAL Guidelines easily accessible, and they are updated monthly. The guides are interactive, so there s no need to scroll! NOTE: We do not recommend printing this extensive GUIDE , as it s updated monthly. If you note any errors in the GUIDE , please contact FHCP PROVIDER Services at 386-317-8809 so that we may make corrections. HELPFUL TIPS FOR REFERRAL GUIDE NAVIGATION: Ctrl + F Brings up the Find function box. Type the specialty in the box, and exact matches will appear to the left of your screen on the Navigation panel. Select your choice, and you ll be directed to the specialty under the Table of Contents.

2 Click on the specialty to go directly to the list of specialists. Alternatively, you may select the specialty of choice in the Table of Contents. Click on the specialty to go directly to the list of specialists. Ctrl + Home will return you to the top of this document. 2 volusia & flagler COUNTIES MAY 2022 PROVIDER REFERRAL GUIDE VOLUSIA/FLAGLER COUNTIES FHCP Central REFERRAL Department Ph: 386-238-3230 or Toll Free: 800-352-9824, Ext 3230 Fax: 386-238-3253 or 855-442-8398 Central REFERRAL Department Manager Sue Schack, LPN Ph: 386-676-7100 or Toll Free: 800-352-9824, Ext 3230 Central REFERRAL Department Clinical Supervisor Jane Vesta, LPN Ph: 386-676-7100 or Toll Free: 800-352-9824, Ext 3230 PROVIDER Relations Manager Roberta Hemphill Ph: 800-352-9824, Ext 7423 or 386-616-5018 flagler & volusia COUNTIES PROVIDER Relations Coordinator Rhonda White Ph: 800-352-9824, Ext 7662 or 386-317-8809 FHCP Case Management Utilization Review Department Ph: 386-676-7187 or Toll Free.

3 866-676-7187 FHCP Case Management Coordination of Care Department Ph: 386-238-3284 or Toll Free: 855-205-7293 PROVIDER Benefits and Eligibility Questions Ph: 386-615-4024 or Toll Free: 844-615-4024 A BLACK BOX Indicates prior authorization is required through the FHCP Central Referrals Department. For URGENT REQUESTS ( , life-threatening or serious jeopardy to health) requiring prior authorization, the requesting PROVIDER must call FHCP Central Referrals at 386-238-3230. Services that require prior authorization must have documentation of medical necessity. If documentation is unavailable, your request may be denied. Please refer to this PROVIDER REFERRAL GUIDE for assistance in referring our patients for services. Note that there are guideline variations for Halifax Employee Care Network (HECN).

4 HALIFAX EMPLOYEE CARE NETWORK (HECN), DAYTONA STATE COLLEGE, BETHUNE-COOKMAN UNIVERSITY, AND volusia COUNTY SCHOOL BOARD MEMBERS CAN SEE ALL LISTED HMO PROVIDERS, AS WELL AS ADDITIONAL PROVIDERS, AS SPECIFIED, WHO HAVE BEEN INDICATED IN GREEN WITHIN THIS DOCUMENT. EXTENDED PROVIDER NETWORK (EPN) PROVIDERS ACCEPTING TRIPLE OPTION PLAN MEMBERS ONLY HAVE THIS PLAN INDICATED IN BLUE WITHIN THIS DOCUMENT. 3 volusia & flagler COUNTIES MAY 2022 TABLE OF CONTENTS acupuncture .. 12 ACUTE LOW back & NECK PROGRAM (1 of 2 pages) .. 13 ALLERGY .. 15 AMBULATORY SURGICAL CENTERS (ASC) .. 16 APPLIED BEHAVIORAL ANALYSIS (ABA THERAPY) .. 16 ARTERIAL BLOOD GASES (ABG) .. 17 AUTISM SPECTRUM DISORDER (ASD) .. 18 BARIATRIC SURGERY PROGRAM .. 19 BEHAVIORAL HEALTH (1 of 16 pages) .. 20 BEHAVIORAL HEALTH CHILD & ADOLESCENT.

5 34 BEHAVIORAL HEALTH INPATIENT SERVICES .. 35 BIRTH CENTERS .. 36 BONE DENSITY STUDIES .. 37 BONE GROWTH STIMULATORS .. 38 BONE SCANS (1 of 2 pages) .. 39 BRACES, ORTHOTICS, AND PROSTHETICS (1 of 2 pages) .. 41 BREAST MRI .. 43 CARDIAC CATHETERIZATION .. 44 CARDIAC MONITORING .. 45 CARDIAC REHABILITATION .. 46 CARDIOLOGY (1 of 5 pages) .. 47 CARDIOLOGY NUCLEAR (1 of 3 pages) .. 52 4 volusia & flagler COUNTIES MAY 2022 CARDIOLOGY PEDIATRIC .. 55 CASE MANAGEMENT COORDINATION OF CARE (1 of 3 pages) .. 56 CHIROPRACTIC (1 of 8 pages) .. 59 COCHLEAR IMPLANT SERVICES .. 67 COLOGUARD TESTING .. 67 COLONOSCOPY SCREENING (1 of 2 pages) .. 68 COLONOSCOPY DIAGNOSTIC (1 of 2 pages) .. 70 COLONOSCOPY CT (VIRTUAL COLONOSCOPY) .. 71 CONTRACEPTION .. 72 CT SCANS (1 of 4 pages) .. 73 DENTAL SERVICES (1 of 3 pages).

6 77 DENTAL SERVICES TMJ SERVICES (3 of 3 pages) .. 79 DERMATOLOGY (1 of 2 pages) .. 80 DIABETIC SHOES (1 of 3 pages) .. 82 DIABETES EDUCATION .. 85 DIALYSIS SERVICES (1 of 2 pages) .. 86 DISEASE MANAGEMENT PROGRAMS (1 of 3 pages) .. 88 DURABLE MEDICAL EQUIPMENT (1 of 3 pages) .. 91 DURABLE MEDICAL EQUIPMENT SPECIAL (2 of 3 pages) .. 92 EAR, NOSE, AND THROAT (ENT) (1 of 2 pages) .. 94 ECHOCARDIOGRAMS (1 of 2 pages) .. 96 ELECTROENCEPHALOGRAM (EEG TESTING) .. 98 EEG TESTING VIDEO (1 of 2 pages) .. 99 EEG TESTING MOBILE SERVICES .. 101 ELECTROCARDIOGRAM (EKG) .. 102 5 volusia & flagler COUNTIES MAY 2022 EMERGENCY FACILITIES .. 103 ELECTROMYOGRAPHY (EMG) (1 of 2 pages) .. 104 ENDOCRINOLOGY (1 of 2 pages) .. 106 EVENT MONITOR .. 108 EXTENDED HOURS CARE CENTERS (EHCC) (1 of 2).

7 109 FLIGHT PHYSICALS Federal Aviation Administration (FAA) Physicals .. 111 GASTROENTEROLOGY (1 of 3 pages) .. 112 GENETIC TESTING/COUNSELING .. 115 GLUCOMETERS .. 116 GYNECOLOGY & WELL WOMAN S ASSESSMENTS (1 of 4 pages) .. 117 GYNECOLOGIC ONCOLOGY .. 120 HAND THERAPY SERVICES .. 121 HEARING & AUDIOLOGY SERVICES .. 122 HEMATOLOGY .. 123 HEPATITIS C SERVICES .. 124 HEPATOBILIARY SERVICES .. 124 HIDA (CHOLESCINTIGRAPHY) SCAN .. 125 HIV (HUMAN IMMUNODEFICIENCY VIRUS) .. 125 HOLTER MONITOR .. 126 HOME HEALTH CARE .. 126 HOME INFUSION PHARMACIES .. 127 HOSPICE .. 128 HOSPITAL ADMISSIONS .. 129 INPATIENT (ACUTE) REHABILITATION FACILITIES .. 130 LONG-TERM ACUTE CARE HOSPITAL ADMISSIONS .. 130 6 volusia & flagler COUNTIES MAY 2022 HOSPITALIST (1 of 2 pages) .. 131 HYPERBARIC OXYGEN THERAPY.

8 132 INFECTIOUS DISEASES (Page 1 of 2) .. 133 INFECTIOUS DISEASES PEDIATRICS .. 134 INFUSION CLINICS .. 135 INFUSION SERVICES INFUSION PUMPS FOR CHEMOTHERAPY .. 135 INJECTION CLINIC .. 136 INSULIN PUMPS (1 of 2 pages) .. 137 INTERPRETER SERVICES (1 of 2 pages) .. 139 DEAF AND HARD OF HEARING SERVICES .. 139 LANGUAGE INTERPRETERS .. 140 LABORATORY SERVICES ROUTINE AND STAT (1 of 4 pages) .. 141 LABORATORY SERVICES IN-HOME .. 145 LACTATION SERVICES & BREASTFEEDING CLASSES .. 146 LITHOLINK SERVICE .. 147 LOOP RECORDERS .. 148 LYMPHEDEMA CLINICS .. 149 MAMMOGRAPHY - DIAGNOSTIC OR SCREENING (1 of 2 pages) .. 150 MEDICATIONS .. 152 MOBILE IMAGING SERVICES .. 153 MAGNETIC RESONANCE IMAGING (MRI) (1 of 3 pages) .. 154 NEPHROLOGY (1 of 2 pages) .. 157 NEUROLOGY (1 of 2 pages) .. 159 NUTRITIONAL SERVICES.

9 161 OBSTETRICS (1 of 2 pages) .. 162 7 volusia & flagler COUNTIES MAY 2022 OCULAR PROSTHETICS LAB .. 164 ONCOLOGY MEDICAL/HEMATOLOGY (1 of 3 pages) .. 165 ONCOLOGY MEDICAL/HEMATOLOGY THERAPY NON-MEDICARE MEMBERS .. 167 ONCOLOGY MEDICAL/HEMATOLOGY THERAPY MEDICARE MEMBERS .. 167 ONCOLOGY RADIATION (1 of 2 pages) .. 168 ONCOLOGY RADIATION THERAPY .. 169 OPHTHALMOLOGY (1 of 3 pages) .. 170 OPHTHALMOLOGY CORNEAL SERVICES ONLY .. 173 OPHTHALMOLOGY RETINAL SERVICES ONLY .. 174 OPHTHALMOLOGY OTHER .. 175 OPTOMETRY (1 of 2 pages) .. 176 OPTOMETRY LOW VISION .. 178 ORAL SLEEP APNEA APPLIANCES .. 179 ORTHOPEDICS & SPORTS MEDICINE NON-SURGICAL TREATMENT .. 180 OUTPATIENT REHABILITATION with Sub-specialties (1 of 13 pages) .. 181 AQUATIC THERAPY .. 181 BALANCE & VESTIBULAR THERAPY.

10 182 HAND THERAPY SERVICES .. 185 INCONTINENCE THERAPY .. 185 OCCUPATIONAL THERAPY .. 186 OSTEOPOROSIS / OSTEOPENIA PROGRAMS .. 187 PEDIATRIC THERAPY & OCCUPATIONAL PEDIATRIC THERAPY .. 188 PHYSICAL THERAPY .. 189 SPEECH THERAPY .. 191 VIDEOSTROBOSCOPY AND VOICE THERAPY EVALUATION .. 193 8 volusia & flagler COUNTIES MAY 2022 PAIN MANAGEMENT (1 of 2 pages).. 194 PALLIATIVE CARE .. 196 PATHOLOGY OUTPATIENT/AMBULATORY .. 197 PEDIATRICS .. 198 PEDIATRIC SUB-SPECIALTIES .. 198 PEDIATRIC SUB-SPECIALITIES - BEHAVIORAL HEALTH See BEHAVIORAL HEALTH CHILD & ADOLESCENT .. 198 PEDIATRIC SUB-SPECIALTIES GASTROENTEROLOGY .. 198 PEG TUBE FEEDING ASSESSMENT .. 199 PELVIC HEALTH PROGRAMS .. 200 PERINATOLOGY .. 201 PERIPHERAL VASCULAR INTERVENTION .. 202 PET SCANS - (1 of 2 pages) .. 203 PHARMACY.