Attendant Compensation Enhancement Program Form
- Texas Standard Prior Authorization Request Form for Health Care Services
- Physical Health Precertification List - Effective 9/1/2017 (to be updated on our STAR+PLUS Provider Manual)
Targeted Case Management and Rehabilitation Service
- Targeted Case Management and Rehabilitation Service Request Form - To request authorization for our Member, complete and fax the form to 877-809-0787 (this form is for authorizations for Targeted Case Management services only. All other authorizations should be submitted on the TDI authorization form for inpatient and other outpatient services).
EVV Recoupment Reconsideration
- EVV Review Request Form (Use only when you have verified visits to submit for reconsideration.)
- EVV Visit Maintenance Unlock Request Form (Use only for dates of services listed on your Request for Refund of Unverified Services letter - NOTE: approval is at MCO's Discretion.)
Interested in joining the Cigna-HealthSpring STAR+PLUS or MMP Network?
Non-contracted Providers Only
Thank you for your expressed interest in the Cigna HealthSpring STAR+PLUS and MMP network. Cigna HealthSpring currently serves STAR+PLUS members in the Tarrant, NE MRSA and Hidalgo SDA, as well as MMP in Hidalgo County.
In order for us to review your request, please complete the network interest form as applicable and allow up to 60 days for our committee to review and provide you with a determination.
Is your office ADA compliant? Please complete the Credentialing/Provider Directory Information form.
Cigna HealthSpring STAR+PLUS and MMP serves members in 50 counties across Texas, to view a list click here: http://starplus.mycignahealthspring.com/servicearea
Contracted Medical or Ancillary Providers
If you are contracted Cigna HealthSpring STAR+PLUS and/or MMP provider and need to add a product, specialty, provider or location to an existing contract please utilize the Provider Information Change Form. For any questions regarding the Provider Change Form, please take a moment to review the FAQ.
Please note, if you are affiliated with a third party Delegate, all changes must be made at the request of the Delegate. Contact your Delegate for additional information.