Programs and Procedures
Check here for a description of Capital Health Plan programs and company procedures that affect your practice.
Capital Health Plan Medical Policies & Clinical Criteria
CHP Programs
Medical Programs
- Prenatal Program
- Colon Screening Program
- Population Health and Disease Management Program
- Diabetes Disease Management Program
- Vascular Disease Management Program
- Radiation Oncology Program
- Wellness Program
- Quit Smoking
Disease Resources
Case Management
Utilization Management Topics
- Referrals and Authorizations
- Utilization Management
- Universal Prior Authorization Form
- Effective 1/1/2017, the Florida Legislature requires all insurers to use the Universal Prior Authorization Form. Therefore, Capital Health Plan will only accept this form when submitted and completely filled out as directed by the instructions. Incomplete forms will not be considered a valid request for services and therefore will not be processed.
For CHP Providers
Patient Safety Information
Health care, like any human endeavor, is not immune to mistakes. In fact, as medicine advances—as treatments become more varied and sophisticated—care necessarily entails additional possibility for error. Patient safety is a continual concern at Capital Health Plan. One important method we use for safeguarding members is education. How can you help ensure that your care is safe and effective?
Steps for Safer Health Care: What You Can Do
- Medications. Make sure both your doctor and pharmacist know all of the medicines that you take, including over-the-counter medications (aspirin, etc.), vitamins, and supplements. Tell them of any drug allergies. Ask your doctor to spell out the name of a prescribed drug and specify the dose. Write this down, so that you can check it against the label on the pharmacy bottle. Either from your doctor or the pharmacist, find out exactly what the drug is for, how to take it (empty or full stomach; time of day), what to avoid while taking it (foods, beverages, or activities), and possible side effects. Read any written information provided about the medicine.
- Tests. Find out the results of any test or diagnostic procedure. When tests are ordered or done (even routine tests) ask when and how you will get the results. If the results are late, call your doctor’s office to inquire. When you have results, ask what they mean for your care.
- Physician-Patient Communication. You should feel comfortable talking with your doctor about your health and treatment. If you have any questions or concerns, express them. Don’t hesitate to ask for a simpler explanation or to take notes. You may want a family member or a friend to accompany you, especially to understand a serious condition.
- Surgery. Be sure you understand what will happen before and after any surgery. Ask the surgeon what he or she will be doing, how long it will take, and what recovery will be like. If the surgery requires hospitalization, ask whether the surgeon or another physician will take charge of your care after the procedure. Before the procedure, clearly specify to the anesthesiologist or nurse any drug allergies or bad reactions to anesthesia.
The web links below provide important consumer health and patient safety information.