GHP Family Provider Manual - Geisinger Health Plan

Please Note: If the ambulance provider’s dispatcher or non-emergency ambulance coordinator receives a request fornon-emergency transport for a Member, please direct the caller to the MTM Call Center at (888) 409-6881.Requests for Level of Service UpgradeAn ambulance provider request for an upgrade to a previously agreed upon level of service must have prior approvalfrom MTM. This includes any of the following examples:• Basic Life Support (BLS) to Advanced Life Support (ALS)• ALS to Specialty Care Transport (SCT)• Additional staff or assist units as may be needed for bariatric transfers, etc.Completion of Transport ServicesOnce transport services are completed, the ambulance provider’s dispatcher or non-emergency ambulance coordinatorshould contact MTM to verify the level of service, report loaded miles, and/or discuss any complications (includingreasons for variations in mileage).More detailed information regarding authorization of non-emergent medical transportation through MTM for GHPFamily Members (including the MTM/GHP Ambulance Provider Manual) is available at www.ghpfamily.com or bycalling your GHP Family Provider Relations Representative at (800) 876-5357.Specialty Pharmacy Vendor ProgramCertain prescription and injectable drugs are covered only through the Specialty Pharmacy Vendor Program. For moredetail and a complete list of drugs available through this program, refer to www.ghpfamily.com.com, or call the GHPFamily Pharmacy Department at (855) 552-6028. Medication requests are the responsibility of the prescribingParticipating Provider.Please note: Precertification may be required for certain drugs. Please refer to the section titled “Other ServicesRequiring Precertification” within this Manual for further information.Specialty Pharmacy Vendor Program ProcessTo initiate the program, the prescribing Participating Provider is required to complete GHP Family’s SpecialtyPharmacy Vendor Request Form and fax it to GHP Family Pharmacy Department at (570) 271-5610. Telephone orderswill not be accepted or processed. The Specialty Pharmacy Vendor Request Form and other information regarding theSpecialty Pharmacy Vendor Program can be found online at www.ghpfamily.com under “Formulary Information.”Notification ProcessUpon receipt of the Specialty Pharmacy Vendor Program Request Form, the Pharmacy Department will:• verify the Member’s eligibility and benefits.• review the form to ensure appropriate information has been provided.• Perform precertification if required.• if approved, forward the form to GHP Family’s contracted specialty vendor.• if denied, GHP Family will send the Member a denial notice with appeal rights information in the requiredtimeframes and send a copy to the prescribing provider.The vendor will process the request and ship the medication to the destination (i.e., provider’s office, Member’sresidence, etc.) identified on the form within forty-eight (48) hours.46