Frequently Asked Questions

Answers for questions about working with Firefly Health if you are a provider. We’re grateful for the tremendous care you provide to our members, and we want to make that as easy as possible for you.

How do I check authorization status?

How do I submit a medical authorization?

Our utilization management partners at MedWatch process medical authorizations for us.

To submit an authorization, you can:

Which medical services require prior authorization?

Check our list of medical services that require prior authorization.

How can I check a patient’s eligibility?

What does the Firefly member ID card look like?

It looks like this:

The Firefly Health Plan Member ID Card
The Firefly Health Plan Member ID Card

Does my practice accept Firefly?

We use First Health for our plan’s network — that’s Aetna’s network. If you belong to First Health, you accept our plan, no problem.

How do I submit a claim?

Send claims electronically to Payer ID FH205. Or submit an HCFA 1500 (CMS-1500) form to Firefly Health PO Box #278 Arnold, MD 21012. Need to check a claim status? Call us at (888) 897-1887.

How do I check claim status?

Need to check a claim status? Call us at (888) 897-1887.

How do I find out why a claim was denied?

How quickly do you process claims?

Usually within 14 days.

How can I correct a claim?

Call 1-888-897-1887. Be sure to submit claim corrections within 12 months of the date of service.

When will I receive an explanation of payment (EOP)?

You’ll get it in the mail 7-10 days after we process the claim.

How much should I charge Firefly members?

Call us at 1-888-897-1887 to find out.

My patient is showing me a Care Pass. Do they really have a $0 copay for my services?

Yes, they do. Their plan covers the full cost of their visit. This is how we reward members for seeing the high-value providers we recommend. Just verify that your name or the name of your facility is on the pass. If you have any questions, call us at 1-888-897-1887.

How will I receive payments?

We pay you through VPay. To create an account over the phone — or if you have questions — call VPay at 1-877-714-3222.

How quickly will I receive payments?

Usually within a week of claims approval. Claims processing typically takes up to 14 days.

Where can I search your formulary?

You can find our formulary on our prescriptions and costs page. Note that drug coverage may vary based on the member’s employer. Call us at 1-888-897-1887 to confirm coverage details.

How do I find alternatives for medications that aren’t in your formulary?

How do I submit a pharmacy authorization?

Our partners at CapRx process pharmacy authorizations for us. To submit an authorization, call 1-888-897-1887.

Or submit a prior authorization form:

  • Fax: 1-833-434-0563
  • Mail: Capital Rx, Inc.
    Attention Prior Authorization Department
    228 Park Avenue South, Suite 87234
    New York, NY 10003-1502

Where do I send mail-order and specialty prescriptions?

Mail-order: E-prescribe prescriptions to Costco Pharmacy #1348

Specialty:  E-prescribe prescriptions to Costco Pharmacy #0134

Which retail pharmacies are in-network?

We have over 60,0000 in-network pharmacies, including national chains and independent pharmacies. Check our list of commonly used pharmacies.