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Published byBarrie Kelly Modified over 9 years ago
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DentaQuest Provider Training Cigna-HealthSpring Effective 9/1/2013
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2 Agenda HealthSpring Plans Effective 9/1/13 STAR+PLUS Value Add STAR+PLUS Waiver
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STAR+PLUS Program STAR+PLUS was created specifically to serve the elderly and persons with disabilities, typically known as the aged, blind and disabled population (ABD) Goal-to achieve a seamless continuum of care by integrating acute and comprehensive care Long-Term Services and Support (LTSS) in a managed care environment Promotes delivery of home and community-based services The health plans are responsible for coordinating acute and LTSS through the use of a Service Coordinator. Service Coordination is the cornerstone of the STAR+PLUS model. 3
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STAR+PLUS Members Mandatory Population Supplemental Security Income (SSI) eligible adult clients (ages 21 and over) Medical Assistance Only (MAO) Clients who qualify for 1915 (c) Nursing Facility Waiver (limited number) Dual Eligibles - those individuals who are covered by Medicare and receive dental benefits or dental value added services Voluntary Population SSI Children under the age of 21 Children (under the age of 21) who are Medicaid eligible because they are in a Social Security Exclusion Program 4
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STAR+PLUS Waiver Program STAR+PLUS Eligible population: Medicaid Waiver and Dual Waiver Adult Members Benefit Limit: $5000 maximum per individual service plan year Covered Waiver Dental Services Treatment of injuries to the teeth or supporting structures Dentures and the cost of fitting and preparation Preventative procedures that are required to prevent the imminent loss of teeth 5
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STAR+PLUS Service Areas HealthSpring Tarrant Hidalgo 6 Recipients must reside in a covered service area of the health plan they are enrolled in.
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HealthSpring STAR+PLUS Value Add STAR+PLUS Value Add Eligible population: Medicaid Only Members Benefit Limit: $500 maximum per benefit year Covered Dental Services Limited preventive and diagnostic services Limited restorative services (see following slide) No UM review required 8
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9 TX HealthSpring STAR+PLUS Value Add $500 Annual Maximum limit applies to all covered codes D0120Periodic oral evaluation - established patient D0140Limited oral evaluation -problem focused D0150Comprehensive oral evaluation - new or established patient D0210 or D0330complete mouth x-rays or panoramic x-rays D0220Intraoral - periapical first film D0230Intraoral - periapical each additional film D0272Bitewings – two films D0274Bitewings – four films D1110Adult prophylaxis D1204 or D1206Topical application of fluoride D21401 surface amalgam D21402 surface amalgam D21603 surface amalgam D2330Resin-based composite - 1 surface, anterior D2331Resin-based composite - 2 surfaces, anterior D2332Resin-based composite - 3 surfaces, anterior D2391Resin-based composite - 1 surface, posterior D2392Resin-based composite - 2 surface, posterior D2393Resin-based composite - 3 surface, posterior D2721Crown - resin with base metal D2751Crown - porcelain with base metal D2791Full cast crown - with base metal D2920Re-cement crown D7140Simple extraction
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HealthSpring STAR+PLUS Waiver STAR+PLUS Eligible population: Medicaid Waiver and Dual Eligible Waiver Adult Members Benefit Limit: $5000 maximum per individual service plan year Covered Waiver Dental Services Treatment of injuries to the teeth or supporting structures Dentures and the cost of fitting and preparation Preventative procedures that are required to prevent the imminent loss of teeth 10
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HealthSpring STAR+PLUS Waiver – Additional Information HealthSpring requires that all services for SPW members are approved by their Service Coordination team prior to rendering services. All services or “treatment plans” must be submitted to DentaQuest on a prior authorization. DentaQuest will coordinate with HealthSpring on final approvals. Standard turn-around-times apply (3 days). Please include the keyword “SPW” in Box 35 of the authorizations. 11
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HealthSpring STAR+PLUS Waiver ID Card Tarrant Service Area 12
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HealthSpring STAR+PLUS Value Add ID Card Tarrant Service Area 13
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HealthSpring STAR+PLUS Waiver ID Card Hidalgo Service Area 14
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HealthSpring STAR+PLUS Value Add ID Card Hidalgo Service Area 15
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16 Questions
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