Health-Care-Providers | Cigna CarePlan of Texas

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 .

IMPORTANT: LTSS Atypical Provider Identifier (API) Reenrollment - Deadline February 1, 2019

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

EVV Failed to Export Report Notification

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

EVV Recoupment Reconsideration:

CHS EVV Visit Maintenance Unlock Guidance

EVV Visit Maintenance Unlock Request Form

Provider Manual

Download this PDF

Table of Contents

Page	Section
6	Introduction
7	Important Phone Numbers
44	Covered Services
53	Emergency Services
10	Medicare-Medicaid Plan Eligibility & Enrollment
65	Utilization Management
72	Billing and Claims Administration
18	Provider Responsibilities
81	Quality Management

Provider Manual For Nursing Facilities

Provider Manual for Nursing Facilities

Table of Contents

Page	Section
9	Important Phone Numbers
10	Introduction
16	Covered Services
18	Behavioral Health Covered Services
22	Prescription Drug Coverage
26	Enhanced STAR+PLUS Benefits
27	Emergency Services
31	STAR+PLUS Eligibility and Enrollment
36	Service Coordination and Disease Management
39	Medical Management/Utilization Management
45	Billing and Claims Administration
77	Provider Responsibilities
89	Quality Management
98	Member Service
109	MMP (Medicare-Medicaid Plan)
119	Provider Complaint and Appeal Process
121	Appendices

HSConnect – Provider Portal

STAR+PLUS HSConnect Information

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

Provider Search Tool

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

Searchable Provider Directory - Cigna 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.

Forms

Payment Dispute Form

Provider Claims Appeals Form

Provider Resources

Provider Complaints and Appeals

Provider Complaints to Cigna

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

Cigna Appeals & Complaints Department	Cigna Provider Services Department	Cigna Provider Portal
PO Box 23269 Nashville, TN 37202 Fax: 1 (877) 809-0783 Email: providerrelationscentral@healthspring.com	8:00 am to 5:00 pm CST Monday to Friday 1 (877) 653-0331 Email: providerrelationscentral@healthspring.com	Log into HSConnect: https://starplus.hsconnectonline.com/login.aspx

If a provider complaint is received verbally, Cigna’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 will send an acknowledgement letter to the provider. Cigna will resolve the complaint within thirty (30) days from the date the complaint was received by Cigna. An email can also be sent to the HHSC State Inbox: HPM_Complaints@hhsc.state.tx.us

Provider Claims Appeals to Cigna

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 Appeals & Complaints Department
PO Box 23269
Nashville, TN 37202
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 requires additional information to process an appeal, the provider must return requested information within twenty-one (21) days from the date of Cigna'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 sends written notification of the resolution to the provider.

Health Care Providers

Provider Complaints and Appeals