Public Health Notice About Severe Lung Disease Among Persons Who Report Vaping

Tobacco Use Cessation Services Provided in a Group Setting

Delegated Psychological Services

2019 MMP ADD File Diagram

NCCI MUE Deactivation – Effective June 1, 2019

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

Therapy Policy Changes FAQ - Effective September 1, 2018

Ordering, Referring and Prescribing Providers FAQ

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

Enterprise Validation Tool

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: https://hhs.texas.gov/about-hhs/communications-events/news/2017/08/blue-button-available-yourtexasbenefitscard.

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

Visit Maintenance Extension

Updates to STAR+PLUS LTSS Billing Matrix and Authorizations

EVV Claim Match Result Code Tip Sheet

HHSC’s Request to Delay Jan. 1, 2020 EVV Start Date is Approved

HHSC Cures Act Extension

HHSC EVV Visit Maintenance Unlock Request Form - effective September 1, 2019

HHSC EVV Visit Maintenance Unlock Request Policy - effective September 1, 2019

EVV Allowable Phone Identifcation Policy - effective September 1, 2019

EVV Billing Policy - effective September 1, 2019

EVV Claims Matching Policy - effective September 1, 2019

EVV Claims Submission Policy - effective September 1, 2019

EVV Compliance Oversight Reviews Policy - effective September 1, 2019

EVV Data Elements Policy - effective September 1, 2019

EVV Reason Code and Required Free Text Policy - effective September 1, 2019

EVV Standard Reports Policy - effective September 1, 2019

EVV Training Policy - effective September 1, 2019

EVV Usage Policy - effective September 1, 2019

EVV Vendor Selection Policy - effective September 1, 2019

EVV Vendor Transfer Policy - effective September 1, 2019

Upcoming Webinars for EVV

LTSS Code Changes – effective September 1, 2019

HHSC EVV Visit Maintenance Unlock Request Policy

EVV Contact Information Matrix

EVV Claims Submission for MCO Providers – effective September 1, 2019

Changes to EVV Vendor System

EVV Upfront Processing Training

2020 MCO PIP Topics

HHSC EVV Live Webinar  - April 22, 2019

HHSC EVV Live Webinar  - March 22, 2019

EVV Mobile Application Policy - effective April 1, 2019

New EVV Provider Data Validation Process

EVV Billing Changes

Reminder EVV Visit Maintenance of MEDsys Historical Data

EVV Tool Kit Modules

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 .

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

CHS EVV Visit Maintenance Unlock Guidance

EVV Recoupment Reconsideration:

CHS EVV Visit Maintenance Unlock Guidance

EVV Recoupment Dispute Request Form (Use only when you have verified visits to submit for reconsideration.)

EVV Visit Maintenance Unlock Request Form

Cigna Contacts
Contact Information
Behavioral Health
Substance Abuse Services
Phone: 1 (877) 725-2539 TTY: 7-1-1
Hours: 8:00 am-5:00 pm (CST), Monday-Friday

Behavioral Health
Crisis Hotline
Phone: 1 (800) 959-4941 TTY: 7-1-1
Hours: 24 hours, 7 days a week

Claims Status Request
Phone: 1 (877) 653-0331 TTY: 7-1-1
Hours: 8:00 am-5:00 pm (CST), Monday-Friday

Compliance Hotline
Phone: 1 (877) 653-0331 TTY: 7-1-1
Hours: 8:00 am-5:00 pm (CST), Monday-Friday
Cigna Automated

Eligibility Verification Line
Phone: 1 (866) 467-3126 TTY: 7-1-1
Hours: 24 hours, 7 days a week

Member Services Department
Phone: 1 (877) 653-0327 TTY: 711
Hours: 8:00 am-5:00 pm (CST), Monday-Friday

Nursing Facility Representative Contacts
Phone:
1 (469) 503-8303 - MRSA NE and Hidalgo
1 (469) 404-7673 - Tarrant and Hidalgo
1 (877) 653-0331 - Claims Status or Reprocessing
Hours: 8:00 am-5:00 pm (CST), Monday-Friday

Utilization Management Concurrent Review and Skilled Nursing Facility
Phone: 1 (877) 725-2688 TTY: 7-1-1
Hours: 8:00 am-5:00 pm (CST), Monday-Friday

Cigna Pharmacy
Phone: 1 (877) 653-0331 TTY: 7-1-1
Hours: 8:00 am-5:00 pm (CST), Monday-Friday

Provider Relations
Email: providerrelationscentral@healthspring.com

Provider Services Department
Phone: 1 (877) 653-0331 TTY*: 7-1-1
Hours: 8:00 am-5:00 pm (CST), Monday-Friday
*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 TTY: 7-1-1
Hours: 8:00 am-5:00 pm (CST), Monday-Friday

Utilization Management
Home Health
Phone: 1 (877) 725-2688 TTY: 7-1-1
Hours: 8:00 am-5:00 pm (CST), Monday-Friday

Utilization Management
Inpatient Intake
Phone: 1 (877) 725-2688 TTY: 7-1-1
Hours: 8:00 am-5:00 pm (CST), Monday-Friday

Utilization Management
Prior Authorization
Phone: 1 (877) 725-2688 TTY: 7-1-1
Hours: 8:00 am-5:00 pm (CST), Monday-Friday

External ContactsContact 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 week

Automated Inquiry System (AIS), Eligibility Verification

Phone: 1 (800) 925-9126

Hours: 24 hours, 7 days a week

Comprehensive Care Program (CCP)

Phone: 1 (800) 846-7470

Hours: 7:00 am – 7:00pm CST

Website: http://www.tmhp.com

Dental (DentaQuest)

Phone: 1 (888) 308-9345 (Providers

Phone: 1 (855) 418-1628 (Members)

Hours: 8:00 am – 8:00 pm CST, Monday-Friday

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: 8:00 am – 5:00 pm CST, Monday-Friday

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

Medicaid Managed Care Helpline

Phone: 1 (866) 566-8989

Website: https://hhs.texas.gov/about-hhs/your-rights/hhs-office-ombudsman

Medicaid Managed Care Helpline TDD

Phone: 1 (866) 222-4306

Website: https://hhs.texas.gov/about-hhs/your-rights/hhs-office-ombudsman

Medical Transportation Program (MTP):

Phone: 1 (877) 633-8747

Hours: 8:00 am-5:00 pm CST, Monday-Friday

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

Prescription Benefits Manager (PBM) OptumRx

Phone: 1 (800) 613-3591

Hours: 8:00 am-5:00 pm CST

Website: http://www.optum.com

Vision (Superior Vision)

Phone: 1 (866) 819-4298 (Providers)

Phone: 1 (800) 879-6901 (Members)

Hours: 8:00 am-5:00 pm CST, Monday-Friday

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 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.

Notice of Change to Authorization Requirements

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 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.

Learn more LTSS waiver eligibility rules

How to request prior authorization for Long Term Support Services

LTSS Billing Guidelines

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.

Fax a Prior Authorization Form to the Service Coordination department at Cigna at 1 (877) 809-0789.

Request a Prior Authorization online through Cigna's Provider Portal.

Speak with a Cigna 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

ACEP Attestation Form

Payment Dispute Form

Provider Claims Appeals Form

Behavioral Health Precertification List

Physical Health Precertification List

Prior Authorization - Inpatient Form

Prior Authorization - Outpatient Form

Targeted Case Management and Rehabilitation Service Request Form

- To request authorization for our Member, complete and fax the form to 1 (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).

Health Care Provider Referral: Disease Management Program

Provider Information Change Form

Practitioner Interest Form

Facility / Ancillary Network Interest Form

Credentialing/Provider Directory Information Form

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

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.

Provider Credentialing

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:

Cigna Appeals & Complaints DepartmentCigna Provider Services DepartmentCigna Provider Portal
P.O. Box 211088
Bedford, TX 76095
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 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 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.

Provider Newsletter

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

2019 Provider Education Town Halls

Area Training Events

We are pleased to announce the following educational opportunities for providers participating in Cigna'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 2019 Provider Training — Hidalgo Service Area

Topic: General MMP CarePlan, 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: October 10, 2019
Time: 9:30 am – 11:30 am

Date: November 05, 2019
Time: 1:30 pm – 3:30 pm

Date: December 03, 2019
Time: 9:30 am – 11:30 am

 

 

 

Year 2019 Provider Training — EVV

Topic: EVV Refresher, Billing Guidelines, Upfront Processing, Data Aggregator, Cure’s Act

Location: Webinar

 

 

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

None at this time

 

 

 

 

 

 

 

 

 

Year 2019 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 an 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

None at the time

 

 

 

Year 2019 Provider Portal Training

Topic: HSConnect Provider Portal and Cigna-HealthSpring Claims Portal

  • View AI and RUG information on your authorization
  • View and download an 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: October 23, 2019
Time: 9:30 am – 11:30 am

Date: November 07, 2019
Time: 1:30 pm – 3:30 pm

Date: December 12, 2019
Time: 9:30 am – 11:30 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

Pay for Quality Care Incentive Program (P4Q) Quick Reference Guide

Behavioral Health Quick Reference Guide

Blood Lead Testing and Case Management – Quick Reference Guide

Change Healthcare User Guide

Chronic Kidney Disease Guide

LTSS Billing Guidelines

HSConnect and Change HealthCare Nursing Facility Portal Guide

Provider Corrected Claims Guide

Provider Quick Reference Guide

Online Training

Patient Driven Payment Model Presentation

EVV Aggregator Provider Training

Provider In-Service Presentation TX MMP

Cultural Competency Training TX MMP - This is a required course.

Special Needs Plan Model of Care Training - This is a required course.

Electronic Visit Verification (EVV) Training

Nursing Facility Provider In-Service Presentation

Visual Aids

Case Management Provider Poster

Medical Transportation Program Wallet Card

The purpose of the Provider Advisory Council (PAC) is to bring leaders in the provider community together with senior management of Cigna 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 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 members and reward providers for working together to achieve those goals.

Cigna 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 operates. Membership on the Council will be in staggered 2 year terms. Cigna 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