TEXAS MMP HEALTH CARE PROFESSIONALS

Cigna-HealthSpring CarePlan Medicare-Medicaid Plan logo    

Texas Medicare-Medicaid Plan

Welcome to the Cigna-HealthSpring Texas Medicare-Medicaid Plan (TXMMP) Health Care Professional page.  We value our relationship with all of our providers and are committed to working with you to meet the needs of your patients, our customers. Learn more about Cigna-HealthSpring's medicare-medicaid plan.

Therapy Policy Changes FAQ - Effective September 1, 2018

Ordering, Referring and Prescribing Providers FAQ

Notice to Prescribers: Mosquito Repellent Benefit

Notice to Pharmacies: Mosquito Repellent Benefit

2017 Texas Medicaid Standing Order for Mosquito Repellent

Pharmacy Assistance Chart

Provider Complaints to HHSC
Providers may file a Complaint with HHSC. Complaints to HHSC must be received in writing and sent to the following address:

Texas Health and Human Services Commission
Health Plan Operations - H-320
P.O. Box 85200
Austin, TX 78708-5200
ATTN: Resolution Services

Providers who have access to the Internet can email complaints:  HPM_Complaints@hhsc.state.tx.us

UPDATE 07/15/16 - Enterprise Validation Tool In compliance with Centers for Medicare and Medicaid Services (CMS) and State regulations, Cigna-HealthSpring CarePlan is implementing front-end HIPAA validation edits for all claims and encounter data submissions. The change is effective August 15, 2016. Read More

On March 17, 2014, the Centers for Medicare and Medicaid Services (CMS) issued new regulations with additional requirements for Medicaid-funded home and community-based services, including Medicaid 1115 waiver programs providing such services. Providers must comply with the new rules by March 17, 2019. As part of the transition to the new rules, the Health and Human Services Commission (HHSC) and the Department of Aging and Disability Services (DADS) are assessing current services and practices. Part of that project is a self-assessment of residential service providers.

For STAR+PLUS, this specifically relates to providers of assisted living facility services or adult foster care services. A survey must be completed for every site at which assisted living facility services or adult foster care services is provided. The four-part survey tool and instructions can be found on the HHSC website at  http://www.hhsc.state.tx.us/medicaid/hcbs/index.shtml . Providers have until July 29th to complete the survey. Please send any questions about the assessment to MCD_managed_care_quality@hhsc.state.tx.us with subject line "HCBS Settings <Provider Name>." Thank you for your assistance with this important initiative.

New 'Blue Button' Accesses Patient Medical Histories:
Medicaid providers can now find their patients' medical histories on YourTexasBenefitsCard.com by accessing the new “Blue Button” functionality.

In one easy click, the “Blue Button” allows providers to view, download, print or export consenting clients’ health information, which is generated from the current database and claims data stored in the Medicaid Claims Administrator System.

For complete details, please visit: <make link> http://www.hhsc.state.tx.us/stakeholder/2015/nov-dec/briefs.shtml#4 .

Read the HHSC Provider Beneficiary Rights Letter - 05/05/2015

Electronic Visit Verification (EVV) Initiative Information

View older EVV updates.

Cigna-HealthSpring Contacts

Contact Information

Behavioral Health

Substance Abuse Services

Phone: 1-877-725-2539

 

Hours: 8am-5pm (CST), M-F

Behavioral Health

Crisis Hotline

Phone: 1-800-959-4941

 

Hours: 24 hours, 7 days a week

Claims Status Request

Phone: 1-877-653-0331

 

Hours: 8am-5pm (CST), M-F

Compliance Hotline

Phone: 1-877-653-0331

 

Hours: 8am-5pm (CST), M-F

Cigna-HealthSpring Automated

Eligibility Verification Line

Phone: 1-866-467-3126

 

Hours: 24 hours, 7 days a week 

Member Services Department

Phone: 1-877-653-0327

 

TTY: 711

Hours: 8am-5pm (CST), M-F

Cigna-HealthSpring Pharmacy

Phone: 1-877-653-0331

 

Hours: 8am-5pm (CST), M-F

Provider Relations

Email: providerrelationscentral@healthspring.com

Provider Services Department

Phone: 1-877-653-0331

 

TTY*: 711

Hours: 8am-5pm (CST), M-F

*This number requires special telephone equipment and is only for people who have difficulties with hearing or speaking. Calls to this number are free.

Utilization Management

Service Coordination

Phone: 1-877-725-2688

 

Hours: 8am-5pm (CST), M-F

Utilization Management Concurrent Review and

Skilled Nursing Facility

Phone: 1-877-725-2688

 

Hours: 8am-5pm (CST), M-F

Utilization Management

Home Health

Phone: 1-877-725-2688

 

Hours: 8am-5pm (CST), M-F

Utilization Management

Inpatient Intake

Phone: 1-877-725-2688

 

Hours: 8am-5pm (CST), M-F

Utilization Management

Prior Authorization

Phone: 1-877-725-2688

 

Hours: 8am-5pm (CST), M-F

External Contacts

 Contact Information

24-Hour Health Information Line:

Call for immediate, reliable information for any health concern.

Phone: 1-855-418-4552

 

Hours: 24 hours, 7 days a waek

Automated Inquiry System

(AIS), Eligibility Verification

Phone: 1-800-925-9126

 

Hours: 24 hours, 7 days a waek

Comprehensive Care

Program (CCP)

Phone: 1-800-846-7470

 

Hours: 7am-7pm CST

Website: http://www.tmhp.com

Dental (DentaQuest)

Phone: 1-888-308-9345 (Providers)
Phone: 1-855-418-1628 (Members)
Hours: 8am – 8pm CST, M-F
Website: http://www.dentaquest.com

 

Change HealthCare

Phone: 1-800-845-6592

 

Website: http://changehealthcare.com

MAXIMUS (Medicaid Managed Care Helpline)

Phone: 1-800-964-2777

 

Hours: 8am-5pm CST, M-F

Website: http://www.maximus.com/medicaid

Medicaid Managed Care Helpline

Phone: 1-866-566-8989

 

Website: http://www.hhsc.state.tx.us ombudsman

Medicaid Managed Care Helpline TDD

Phone: 1-866-222-4306

 

Website: http://www.hhsc.state.tx.us/ombudsman

Medical Transportation

Program (MTP):

Phone: 1-877-633-8747

 

Hours: 8am-5pm (CST), M-F

Website: https://www.dshs.texas.gov/
cshcn/mtp.shtm

Prescription Benefits Manager (PBM) OptumRx

Phone: 1-800-613-3591
Hours: 8am-5pm (CST)

 

Website: http://www.optum.com

Vision (Superior Vision)

Phone: 1-866-819-4298 (Providers)
Phone: 1-800-879-6901 (Members)
Hours: 8am – 8pm CST, M-F
Website: http://www.superiorvision.com/

 

STAR+PLUS HSConnect Information

HSConnect Provider Portal - Click here to get connected and obtain access.

STAR+PLUS and CarePlan (MMP) Provider Directory and Search

Searchable Provider Directory - Cigna-HealthSpring works with many Primary Care Providers (PCP), specialists and hospitals to meet our Member’s health care needs. With this tool, they can find health care providers in their area.

To download a Provider Directory, please click here.

Prior Authorizations

In an effort to process your request in a timely manner, please submit any pertinent clinical information (i.e. progress notes, treatment rendered, test/lab results or radiology reports) to support the request for services.Any request for a non-contracted provider must include documentation to substantiate the reason for the request. (When all required information has been submitted we will complete your request within 3 business days.)

Prior Authorization - Inpatient Form

Prior Authorization - Outpatient Form

Long Term Support Services Providers

Cigna-HealthSpring offers Service Coordination for CarePlan Members in an effort to work collaboratively with Providers and Members to assess Member health needs, create a care plan, organize services and monitor progress toward a Member’s individual health goals. In addition, the Service Coordination team assists with long term services and supports such as adult foster care, adult day care, personal attendant services, minor home modifications, and home delivered meals. To reach a Service Coordinator, providers can call 1-877-725-2688.

Need more information about LTSS waiver eligibility rules?
Learn more

How to request prior authorization for Long Term Support Services

LTSS Billing Guidelines <link to PDF: hcp-ltss-billing-guidelines.pdf>

Prior Authorization - Long Term Support Services

How to Request Prior Authorization for Long Term Support Services:

There are three ways to request a prior authorization for Long Term Support Services.

  1. Fax a Prior Authorization Form to the Service Coordination department at Cigna-HealthSpring at 1-877-809-0789.
  2. Request a Prior Authorization online through Cigna-HealthSpring's Provider Portal.
  3. Speak with a Cigna-HealthSpring representative in the Prior Authorization Department by calling 1-877-725-2688.

To determine the status of an authorization request, call the Service Coordination Department at 1-877-725-2688.
Authorizations for Long Term Support Services are issued for up to twelve (12) months, depending on the service requested.

IMPORTANT NOTICE: Diagnosis Change for ICD-10

Update Your Information
Ensure your office is properly listed in the Cigna-HealthSpring Provider Directory and that your claims payments are sent to the correct address by providing timely, advance notification of demographic changes. Complete the Provider Information Change Form. For any questions regarding the Provider Change Form, please take a moment to review the FAQ

PCP Panel Reports
On a monthly basis, Cigna-HealthSpring supplies each PCP with a Member panel report. The report contains a listing of all Members assigned to the PCP's membership panel and is sent to PCPs within five (5) days of receiving State eligibility files. PCPs are responsible for providing and/or coordinating care for the all Members on the report.

You can access your PCP panel report by going to the Cigna-HealthSpring Provider Portal. If a Member does not appear on your PCP's panel report, call the Cigna-HealthSpring Provider Services Department to verify the Member’s PCP assignment at 1-877-653-0331.

Provider Credentialing
If you are not a Cigna-HealthSpring STAR+PLUS Provider, but you are interested in joining our network, please fill out the appropriate form below. For additional information contact us by phone or e-mail at: STAR+PLUS Provider Support Team via telephone at 1-877-653-0331 or via email < mail to> MedicaidProviderOperations@healthspring.com

Practitioner Interest Form

Facility / Ancillary Network Interest Form

Fax completed form and requested documents to 1-877-440-7260.

Provider Complaints and Appeals

Provider Complaints to Cigna-HealthSpring 
Provider Complaints can be filed verbally, in writing or through our Provider Portal by contacting Cigna-HealthSpring as follows:

Cigna-HealthSpring Appeals & Compliants Department

Cigna-HealthSpring Provider Services Department

Cigna-HealthSpring Provider Portal

P.O. Box 211088
Bedford, TX 76095
Fax: 1-877-809-0783
Email:
providerrelations
central@healthspring.com

8am to 5 pm CST Monday to Friday
1-877-653-0331
Email:
providerrelationscentral@healthspring.com

Log into HSConnect:
https://starplus.hsconnect online.com/login.aspx

If a provider complaint is received verbally, Cigna-HealthSpring’s Provider Services Representatives collect detailed information about the complaint and route the complaint electronically to the Appeals and Complaint Department for handling. Within five (5) business days from receipt of a complaint, Cigna-HealthSpring will send an acknowledgement letter to the provider. Cigna-HealthSpring will resolve the complaint within thirty (30) days from the date the complaint was received by Cigna-HealthSpring.  An email can also be sent to the HHSC State Inbox: HPM_Complaints@hhsc.state.tx.us

Provider Claims Appeals to Cigna-HealthSpring
Providers must request Claim Appeals within 120 days from the date of remittance of the Explanation of Payment (EOP).
Providers may fax written Claims Appeals to 1-877-809-0783 or mail them to:

Cigna-HealthSpring
Appeals and Complaints Department
P.O. Box 211088
Bedford, Texas 76095
Email: providerrelationscentral@healthspring.com
An acknowledgement letter is sent within five (5) business days of receiving a provider’s written Claim Appeal. In the event that Cigna-HealthSpring requires additional information to process an appeal, the provider must return requested information within twenty-one (21) days from the date of Cigna-HealthSpring's request. If the requested information is not received within this time, the case will be closed. Provider Claim Appeals are resolved within thirty (30) days of receipt of the Claim Appeal. Cigna-HealthSpring sends written notification of the resolution to the provider.

Provider Newsletter

Read Cigna-HealthSpring's Network Insider provider newsletter for news you can use.

Summer 2017

Spring 2017

STAR+PLUS Provider Education

Area Training Events

We are pleased to announce the following educational opportunities for providers participating in Cigna-HealthSpring's CarePlan (Medicare-Medicaid Plan). To insure that there is adequate seating and refreshments and that you receive the webinar information, RSVP to Provider_Training@HealthSpring.com and provide the following information:

  1. City in which you are registering for an event
  2. Date in which you are registering to attend an event
  3. Time for which you are registering for an event
  4. Name of provider entity
  5. First and last names and professional title of each person registering for the event
  6. Phone number, fax number and email

IMPORTANT: You must receive a confirmation email to be able to attend, or to provide you with the webinar link and phone number to view and listen to the training from your computer.

Year 2017 Provider Training — Hidalgo Service Area

Topic: General Orientation, Provider Portal, Authorizations and Claims

Location: Webinar

 

   

RSVP Required Indicate in your RSVP email request the date and time you would like to attend

Date: January 12, 2017

 

Date: February 07, 2017

 

Date: March 21, 2017

 

Time: 9:30 am – 11:00 am

 

Time: 1:30 pm – 3:00 pm

 

Time: 9:30 am – 11:00 am

 

Date: April 12, 2017

 

Date: May 12, 2017

 

Date: June 29, 2017

 

Time: 1:30 pm – 3:00 pm

 

Time: 9:30 am – 11:00 am

 

Time: 1:30 pm – 3:00 pm

 

Date: July 12, 2017

 

Date: August 03, 2017

 

Date: September 27, 2017

 

Time: 9:30 am – 11:30 am

 

Time: 1:30 pm – 3:30 pm

 

Time: 9:30 am – 11:30 am

 

Date: October 05, 2017

 

Date: November 02, 2017

 

Date: December 14, 2017

 

Time: 1:30 pm – 3:30 pm

 

Time: 9:30 am – 11:30 am

 

Time: 1:30 pm – 3:30 pm

 

Year 2017 Provider Portal Training — Nursing Facility

Topic: HSConnect Provider Portal and Cigna-HealthSpring Claims Portal

  • View AI and RUG information on your authorization
  • View and download and electronic EOP
  • Search for claims status
  • And much more!
Location: Webinar

 

   

RSVP Required Indicate in your RSVP email request the date and time you would like to attend

Date: August 18, 2017

 

Date: September 05, 2017

 

Date: October 03, 2017

 

Time: 9:30 am – 11:00 am

 

Time: 1:30 pm – 3:00 pm

 

Time: 9:30 am – 11:00 am

 

Date: August 30, 2017

 

Date: September 22, 2017

 

Date: October 25, 2017

 

Time: 1:30 pm – 3:00 pm

 

Time: 9:30 am – 11:00 am

 

Time: 1:30 pm – 3:00 pm

 

Date: November 09, 2017

 

Date: December 04, 2017

 

 
Time: 9:30 am – 11:00 am

 

Time: 1:30 pm – 3:00 pm

 

 
Date: November 29, 2017

 

Date: December 15, 2017

 

 
Time: 1:30 pm – 3:00 pm

 

Time: 9:30 am – 11:00 am

 

 

Clinical Practice Guidelines

Discover clinical guidelines spanning multiple diagnoses. Read more.

Disease Management Program

Improving Kidney Disease Outcomes. Read more.

Texas State Medicaid Resources for STAR+PLUS Providers

Information / Reference Guides

Online Training

Visual Aids

General Compliance and Fraud, Waste, and Abuse Training

The purpose of the Provider Advisory Council (PAC) is to bring leaders in the provider community together with senior management of Cigna-HealthSpring to discuss issues important to the STAR+PLUS program.The PAC meets quarterly with the leaders of your organization. Together, we can:

Understand how managed care impacts provider business operations – and ways that Cigna-HealthSpring can ease operational burdens.

Learn how providers – hospitals, physicians, long-term services and supports, ancillary, and pharmacy providers – can work together to improve clinical outcomes for our members and your patients.

Develop industry-leading provider and member initiatives that measurably impact quality outcomes for Cigna-HealthSpring members and reward providers for working together to achieve those goals.

Cigna-HealthSpring will establish and conduct quarterly meetings with Network Providers. Membership in the Provider Advisory Council(s) must include, at a minimum, acute, community-based LTSS, and pharmacy providers. A separate Provider Advisory Council will be established in each Service Delivery Area where Cigna-HealthSpring operates. Membership on the Council will be in staggered 2 year terms. Cigna-HealthSpring attendees will include representation from Provider Relations, Health Services and Service Coordination.

To become a part of the Provider Advisory Council, please contact Provider Relations Central at: providerrelationscentral@healthspring.com

Member Website:

Texas Medicare-Medicaid Plan

Member Rights and Responsibilities:

Read more about Member Rights and Responsibilities.