Update Your Information
Ensure your office is properly listed in the Cigna 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 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 Provider Portal. If a Member does not appear on your PCP's panel report, call the Cigna Provider Services Department to verify the Member’s PCP assignment at 1 (877) 653-0331.
If you are not a Cigna STAR+PLUS Provider, but you are interested in joining our network, please fill out the appropriate form below. For additional information contact the STAR+PLUS Provider Support Team via telephone at 1-877-653-0331 or via email MedicaidProviderOperations@healthspring.com
Practitioner Interest Form
Facility / Ancillary Network Interest Form
Is your office ADA compliant? Please complete the Credentialing/Provider Directory Information Form.
Fax completed forms and requested documents to 1 (877) 440-7260.
Credentialing Information for ALL Provider Types
Ancillary, Facility, and Long-Term Services and Support (LTSS) Providers
Complete either the new TAHP facility application or use the new Availity portal to submit information for credentialing or recredentialing. Availity is a free, online web portal, which allows you to submit and maintain your credentialing information in an electronic form. To access the Availity portal, select the following link: https://www.availity.com/. For new users, select the Register button.
Access the recently updated TAHP facility application
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:
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:
Appeals and Complaints Department
P.O. Box 211088
Bedford, Texas 76095
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.
Fraud, Waste, and Abuse and Abuse, Neglect and Exploitation
Abuse, Neglect, or Exploitation online training is available. This training is designed to meet the basic ANE training requirements for staff providing direct care in a community setting. By the end of the training, staff should be able to identify which acts constitute ANE, how to recognize ANE, understand risk factors for ANE, and what methods can be used to address ANE. Additionally, this training includes an introduction to trauma and its impact on the people we serve. Read More.
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