Day: July 15, 2021

DENTAL

Medicare Advantage – CHRISTUS Health Plan

Part D Prescription Drugs

The CHRISTUS Health Plan Generations Medicare Plan includes coverage of
Medicare Part D prescription drugs, as well as those covered under Medicare
Part B. The following chart depicts the pharmacy related services provided
by CHRISTUS Health Plan Generations, the entity responsible for providing
or addressing questions regarding the service, as well as the contact
information.

Pharmacy Related Service

Part D Prescription Drugs (ESI)

Pharmacy Department: 1-844-470-1531
Pharmacy Help Desk: 1-800-922-1557
Pharmacy Fax Number: 1-877-329-3760

Coverage Determination (ESI)
Standard/Expedited Coverage Review: 1-800-935-6103

Formulary Exceptions (ESI)

Coverage Review:

1-800-935-6103

ePA Coverage Review:

Learn More

Medication Therapy Program (ESI)

Pharmacy Department: 1-844-470-1531

Pharmacy Help Desk: 1-800-922-1557

Fax Number: 1-877-329-3760

Covered Vaccines Under Part B (CHRISTUS)

Member Services: 1-844-282-3026

Covered Vaccines Under Part D (ESI)

Fax claim form to: 1-608-741-5483

Express Scripts:

Attn: Med D Claims

P.O. Box 2858

Clinton, IA 52733-2858

Pharmacy claims are processed by Express Scripts (ESI),

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DENTAL

Individual & Family Plans – CHRISTUS Health Plan

CHRISTUS Health Plan includes coverage for prescription drugs. Pharmacy
claims are processed by Express Scripts (ESI), the CHRISTUS Health Plan
pharmacy benefit management vendor. The formulary includes coverage of
generic drugs, as well as many brand-name drugs, non-preferred brands and
specialty drugs. Formularies are reviewed by a Pharmacy and Therapeutics
Committee composed of provider and pharmacists. Providers can view a copy
of the formulary on the CHRISTUS Health Plan website. Some of these drugs
have precertification or step-therapy requirements or quantity limits,
defined as:

  • Prior Authorization (PA): CHRISTUS Health Plan requires the provider to
    get prior authorization before the drug will be approved for coverage,
  • Quantity Limits (QL): For certain drugs, CHRISTUS Health Plan limits
    the amount of the drug it will cover for a given duration of time (i.e.
    30 pills every 30 days).
  • Step Therapy (ST): In some cases, CHRISTUS Health Plan requires trial
    and failure of
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DENTAL

Provider Management – CHRISTUS Health Plan

Care Management

According to the Case Management Society of America, care management is a
collaborative process that assesses, plans, implements, coordinates,
monitors and evaluates options and services to meet an individual’s health
needs through communication and available resources to promote quality,
cost-effective outcomes.

We attempt to assist in the efficient utilization of medical resources for
members with special health care needs, including highly complex chronic
and catastrophic cases to improve access to quality care and avoid
unnecessary medical costs.

Members who might benefit from these services are identified for care
management through utilization management activities, health risk
assessments and screening of administrative data.

Treating providers may refer members for care management services by
contacting the Medical Management Department at the numbers at the bottom
of this page. Members may also self-refer for care management.

Disease Management

There are currently Disease Management programs for asthma and diabetes.
Members receive education, coaching

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DENTAL

Prior Authorization – CHRISTUS Health Plan

Some health care services require prior authorization before members receive them. If members do not follow our requirements for prior authorization, CHRISTUS Health Plan may not pay for the services. In most cases, physicians and other providers will be responsible for getting the prior authorization from the health plan. We have instructions and procedures in place for providers to request prior authorization.

The clinical department will evaluate the request to assess the Medical Necessity and coverage of proposed treatment. CHRISTUS Health Plan will also check that the treatment is being provided at the appropriate level of care. Prior authorizations are approved or denied based on current evidence- based clinical standards of care and guidelines and not on incentives or bonus structures. The member and provider will receive notification of CHRISTUS Health Plan’s decision, whether approved or denied.

Generally, the following types of services require prior authorization:

  • Surgery
  • Durable Medical Equipment
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DENTAL

Join Our Provider Network – CHRISTUS Health Plan

We are dedicated to providing high-quality, cost-effective, outcomes-oriented care to our members. You are our ally in achieving that goal, and we are grateful for your participation.

In support of our commitment to high-quality health care for our members, we have formal, structured credentialing and contracting processes in place for new providers.

To apply to join our network, please complete a letter of interest and the completed Prospective Provider Form, and fax to or email to addresses below:

CHRISTUS Health Plan
Fax: 469-282-3012
Email: CHP.networkdevelopment@christushealth.org

You can also call 1-844-282-3100 with questions or suggestions. Upon receiving your letter and your Prospective Provider Form, you must complete the following steps to be eligible and meet the following criteria to provide care to our members:

  • Have privileges at a participating hospital as applicable to your specialty type
  • Hold a current and valid state medical license to practice, free of sanctions, board orders,
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FITNESS

Fitness & Instruction in Great Falls

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FITNESS

Carcass of alligator discovered in Sumner County, Kansas

SUMNER COUNTY, KS (KCTV) — Game wardens for the Kansas Wildlife, Parks & Tourism department said the carcass of an American Alligator was found in Sumner County, KS recently.



a close up of a reptile


© Kansas Wildlife, Parks & Tourism – Game Wardens


It was found by an employee from the Kansas Department of Transportation while they were working near the Ninnescah River.

Wardens issued a warning to Kansans regarding the discovery.

“This a reminder that even though they might be cute babies, they will grow up to be a dangerous predator,” a statement said. “They grow a foot per year for their first ten years of life, after which the rate of growth slows. People never really think about the consequences of having an animal that is meant to live in the wild and trying to raise it as a pet. A captive raised alligator, even if it’s for only a year or so,

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