Cigna-HealthSpring STAR+PLUS

HHSC Notifications

• EVV Tool Kit Module 2 - EVV roles and responsibilities

  • Alert: EVV Tool Kit Module 2 - EVV roles and responsibilities

• EVV Visit Maintenance of MEDsys Historical Data

• Read-only Access to EVV Data for Providers Not Active with an Approved EVV Vendor
  Medicaid providers who were required to use EVV and who are not active with a current HHSC state approved EVV Vendor can request 30 days of read-only access to their historical EVV visit data by completing the EVV Data Access Request Form.

• EVV Tool Kit Module 1 – Introduction to EVV will help prepare contract providers and Consumer Directed Services (CDS) employers to use EVV.

  • 21st Century Cures Act: Texas EVV Implementation

• Accessing Historical EVV Records Held by Sandata

• Unaffiliated Third Party Regarding EVV

• Potential Evaluation of Increasing EVV Vendor Pool

• Proprietary EVV System Survey for Providers

• Final Reminder to Transitioning EVV Providers

• Access to MEDsys Data

• MCO LTSS Quick Tips

• Reminder to EVV Providers Transitioning to DataLogic

• 21st Century Cures Act & Electronic Visit Verification

• EVV Providers Transitioning to DataLogic

• Notice of Billing Policy Changes to Providers Required to Use EVV

• EVV Revises Unallowable Phone ID & Recoupment Policy

• Transitioning Providers: EVV Claims May Be Denied or Recouped

• Transitioning Providers FAQs and Reminder Instructions

• EVV Electronic Authorization Pilot

• Important Revision to MEDsys-Issued SAD Return Policy

• Visit Maintenance Reduction Solutions

• EVV Transition Timeline

• Temporary Reduction to EVV Compliance Plan - Updated

• IMPORTANT: LTSS Atypical Provider Identifier (API) Reenrollment - Deadline July 1, 2018

• Ordering, Referring and Prescribing Providers FAQ

• Therapy Policy Changes FAQ - Effective September 1, 2017

• Medicaid Breast and Cervical Cancer (MBCC) - Effective September 1, 2017

• TMHP PROVIDER DIS-ENROLLMENT: Patient Protection and Affordable Care Act Deadline has Passed and Dis-enrollment from Texas Medicaid will occur January 31, 2017.Learn More

• Nursing Facility Services Transitioning to STAR+PLUS:Common Reasons for Denials and Rejections of Managed Care Claims

• Electronic Visit Verification (EVV) Initiative Information

• Texas Health and Human Services Commission Nursing Facility Unit Rates

• "Blue Button" Accesses Patient Medical Histories - Medicaid providers can now find their patient's medical histories on YourTexasBeneiftsCard.com by Accessing the new "Blue Button" functionality. Find out more.

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General Updates

• LTSS Code and Modifier Change Delayed

• CVO Provider Alert and Availity Guidance - URGENT

• Credentialing Verification Organization (CVO) Training for Nursing Facilities

• Credentialing Training on the Availity Portal – click here to register

• Credentialing Verification Organization (CVO) – Effective January 1, 2018

  • Credentialing Verification Organization (CVO) Provider FAQ

• Type of Bill Code notification – effective May 1, 2018

• Long-Acting Reversible Contraception (LARC)

• National Drug Code Requirements - Effective February 1, 2018

• Nursing Facility Provider Representative contact information effective May 15, 2017

• View the updated Long Term Support Services (LTSS) Billing Guidelines here!

• Provider Trainings for Hidalgo SDA, Tarrant SDA and MRSA Northeast are available! Join us for webinars and provider training!

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Welcome to the Cigna-HealthSpring STAR+PLUS Plan

Based in Nashville, Tennessee, Cigna-HealthSpring started in 2000. It’s now one of the country’s largest and fastest-growing coordinated care plans whose primary focus is Medicare Advantage plans. Cigna-HealthSpring has Medicare Advantage plans in Alabama, Arkansas, Delaware, Florida, Georgia, Illinois, Indiana, Maryland, Mississippi, North Carolina, New Jersey, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, West Virginia, and Washington, D.C., as well as a national stand-alone prescription drug plan. Given our long partnership with dual-eligible beneficiaries, we are very excited to offer services to our valued members by expanding into Medicaid health care across many states.

We value our relationship with all of our Providers and are committed to working with you to meet the needs of your patients, our Members. Discover the Cigna-HealthSpring difference and learn more about our Medicaid plans.

Cigna-HealthSpring recognizes the immeasurable contribution that you, as a Provider, make to the STAR+PLUS program. To ensure you have access to all of the resources and tools needed to support Cigna-HealthSpring Members, Cigna- HealthSpring’s Provider Services team is available. Provider Services can assist you when you have questions or need to schedule an educational in-service. They also can assist you when daily operations do not go as planned and you need help resolving a problem.

• Verify eligibility, benefits, and prior authorizations on file

• Receive assistance in finding the correct departments

• Verify claims receipt or review claim status

• Process demographic changes such as PCP on file, and member or provider address changes

• Receive assistance with Cigna-HealthSpring’s public website & secure Provider Portal

Credentialing Information for ALL Provider Types

• Effective April 1, 2018, Texas Medicaid MCOs will implement a new NCQA certified Centralized Credentialing Verification Organization (CVO) that will be responsible for performing Primary Source Verification (PSV) for all newly credentialing and re-credentialing Medicaid providers currently enrolled or seeking to participate in Texas Medicaid.  View the Introduction to the Texas CVO presentation.

• To view the webinar, presentation, updated FAQ, and new facility application with instructions, refer to this link http://connect.tahp.org/news/379282/CVO-Implementation-Updates.htm

• Learn how to use the Availity portal to complete the credentialing process (no cost to Providers), refer to this link: https://360.articulate.com/review/content/ce05cf82-dd85-4c73-9368-0a081fb42574/review

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Provider Services

Call: 1-877-653-0331 - Monday to Friday 8 a.m. to 5 p.m. Central Time. Calls to this number are free.

Provider Relations

You can contact Provider Relations by emailing: ProviderRelationsCentral@healthspring.com

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Member Rights and Responsibilities

Read more about the rights afforded members and the responsibilities they have as part of the plan.

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Provider Advisory Council

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

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