DentaQuest Provider Training
Cigna-HealthSpring
Agenda
 HealthSpring Plans Effective 9/1/13
 STAR+PLUS Value Add
 STAR+PLUS Waiver
2
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
 Recipients must reside in a covered service area of
the health plan they are enrolled in.
HealthSpring
Tarrant
Hidalgo
6
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
TX HealthSpring STAR+PLUS Value Add
$500 Annual Maximum limit applies to all covered codes
D0120
D0140
D0150
Periodic oral evaluation - established patient
Limited oral evaluation -problem focused
Comprehensive oral evaluation - new or established patient
D0210 or D0330
D0220
D0230
D0272
D0274
D1110
D1204 or D1206
D2140
D2140
D2160
D2330
D2331
D2332
D2391
D2392
D2393
D2721
D2751
D2791
D2920
D7140
complete mouth x-rays or panoramic x-rays
Intraoral - periapical first film
Intraoral - periapical each additional film
Bitewings – two films
Bitewings – four films
Adult prophylaxis
Topical application of fluoride
1 surface amalgam
2 surface amalgam
3 surface amalgam
Resin-based composite - 1 surface, anterior
Resin-based composite - 2 surfaces, anterior
Resin-based composite - 3 surfaces, anterior
Resin-based composite - 1 surface, posterior
Resin-based composite - 2 surface, posterior
Resin-based composite - 3 surface, posterior
Crown - resin with base metal
Crown - porcelain with base metal
Full cast crown - with base metal
Re-cement crown
Simple extraction
9
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 Card
Tarrant Service Area
12
HealthSpring STAR+PLUS
Value Add ID Card
Tarrant Service Area
13
HealthSpring STAR+PLUS
Waiver ID Card
Hidalgo Service Area
14
HealthSpring STAR+PLUS
Value Add ID Card
Hidalgo Service Area
15
Questions
16