Providers

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.

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.

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

How can I check a patient’s eligibility?

Which medical services require prior authorization?

Check our list of medical services that require prior authorization.

How do I submit a medical authorization?

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

To submit an authorization, you can:

How do I check authorization status?

How do I submit a claim?

Send claims electronically to Payer ID FH205.

Or send us an HCFA 1500 (CMS-1500) form:

How do I check claim status?

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.

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.

Where do I send mail-order and specialty prescriptions?

You have 2 options:

  1. E-prescribe: send prescriptions to GeniusRx
  2. Fax: 1-833-308-0115 (be sure to include member contact information)

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 send in 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

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

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.