PROVIDERS
Frequently Asked Questions
How do I check authorization status?
Call 1-888-897-1887.
How do I submit a medical authorization?
Our utilization management partners at MedWatch process medical authorizations for us.
To submit an authorization, you can:
- Complete an online precertification form
- Call 1-888-897-1887
Which medical services require prior authorization?
Check our list of medical services that require prior authorization.
How can I check a patient’s eligibility?
Call 1-888-897-1887.
What does the Firefly member ID card look like?
It looks like this:
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?
Call 1-888-897-1887.
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?
Call 1-888-897-1887.
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
Which drugs require prior authorization?
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.
