DentaQuest Provider TrainingCigna-HealthSpringEffective 9/1/2013

2

Agenda

HealthSpring Plans Effective 9/1/13 STAR+PLUS Value Add STAR+PLUS Waiver

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

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

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

STAR+PLUS Service Areas

HealthSpring

Tarrant

Hidalgo

6

Recipients must reside in a covered service area of the health plan they are enrolled in.

7

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

9

TX HealthSpring STAR+PLUS Value Add$500 Annual Maximum limit applies to all covered codes

D0120 Periodic oral evaluation - established patient D0140 Limited oral evaluation -problem focusedD0150 Comprehensive oral evaluation - new or established patient

D0210 or D0330 complete mouth x-rays or panoramic x-raysD0220 Intraoral - periapical first film D0230 Intraoral - periapical each additional film D0272 Bitewings – two filmsD0274 Bitewings – four filmsD1110 Adult prophylaxisD1204 or D1206 Topical application of fluoride D2140 1 surface amalgamD2140 2 surface amalgamD2160 3 surface amalgam D2330 Resin-based composite - 1 surface, anterior D2331 Resin-based composite - 2 surfaces, anterior D2332 Resin-based composite - 3 surfaces, anterior D2391 Resin-based composite - 1 surface, posteriorD2392 Resin-based composite - 2 surface, posteriorD2393 Resin-based composite - 3 surface, posteriorD2721 Crown - resin with base metal D2751 Crown - porcelain with base metal D2791 Full cast crown - with base metal D2920 Re-cement crown D7140 Simple extraction

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

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

HealthSpring STAR+PLUS Waiver ID CardTarrant Service Area

12

HealthSpring STAR+PLUS Value Add ID CardTarrant Service Area

13

HealthSpring STAR+PLUS Waiver ID CardHidalgo Service Area

14

HealthSpring STAR+PLUS Value Add ID CardHidalgo Service Area

15

16

Questions