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TexanPlus Healthcare HMO Logo
Need help? Call 1-866-230-2513
(TTY for hearing impaired 711)
8:00 a.m. to 8:00 p.m. in your local time zone, 7 days a week
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2013 TexanPlus® HMO – Houston/Beaumont Area

  • Collpase Menu
    • 2013 plan overview
    • Plan benefits
    • Plan information and forms
      • Member FAQ
      • Low income subsidy (Extra Help)
      • Understanding your coverage
      • Selecting a primary care physician
      • Plan documents
      • Additional forms and documents
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    • Enrollment information
      • Enroll now
      • Do I qualify?
    • Learn about formulary and prior authorizations
      • Formulary information
      • Exceptions and prior authorizations
      • Restrictions to the formulary
      • MTM programs
      • Part D appeals and grievances
      • Prescription drug forms
    • Review notices and policies
      • Transition policy
      • Out-of-network coverage
      • How to disenroll
      • Appeals and grievances
      • Medicare fraud
      • Quality improvement
    • Nifty after Fifty
    • Member email sign up
    • For providers and pharmacies
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Find a doctor
covered by this plan

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Find a drug
covered by this plan

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Find a hospital
covered by this plan

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Find a pharmacy
covered by this plan

View all the plans available in your area:
Have a licensed insurance agent contact me.

Information for Healthcare Providers and Pharmacies

Welcome

The Provider Portal

The Provider Portal enables providers to conduct a wide range of self-service transactions and inquiries in a secure online environment. These services include eligibility inquiry, benefit summaries, claim status, and validation of referrals and authorizations.

Services available on the Provider Portal are:

  • Provider level demographic detail
  • Member Eligibility detail
  • Benefit Summary for eligible members
  • Claims detail
  • Submit and validate authorizations
Log into the Provider Portal

Additional Provider Resources

  • CMS Sequestration Information (PDF)
  • New EOP Information – CMS Sequestration (PDF)
  • 5010 Billing Update (PDF)
  • 2012 TexanPlus HMO Southeast Provider Manual (PDF)
  • Provider Quick Reference Sheet (PDF)
  • EDI Flyer (PDF)
  • Waiver of Liability - Non-contracted providers (PDF)
  • Provider Payment Dispute Resolution Form - Houston (PDF)
  • Provider Payment Dispute Resolution Form - Golden Triangle (PDF)
  • Provider Payment Dispute Resolution Instructions for Non-Contracting Providers (PDF)
  • Medicare Part D Resources:
    • Formulary Information
    • Prescription Drug Forms

Medicare Fraud, Waste and Abuse Training

Please view the following Fraud, Waste and Abuse Training and Fact Sheets for:

Pharmacies
  • Training materials (PDF)
  • Fact Sheet (PDF)

Providers
  • Training materials (PDF)
  • Fact Sheet (PDF)

Entities That Support Medicare Activities
  • Training materials (PDF)
  • Fact Sheet (PDF)

Sample 2013 Member ID Cards

  • Medicare Advantage (MA) - Sample Member ID Card (PDF)

Provider Compliance Education

Compliance Program
  • First-tier, downstream, and related entities (FDR) Disciplinary Form (PDF)
  • FDR Disciplinary Cover Letter (PDF)
  • Office of Inspector General (OIG) Exclusion List – FAQs (PDF)
  • OIG-GSA Fact Sheet (PDF)

Fraud, Waste, and Abuse (FWA)
  • FWA Fact Sheet (PDF)
  • FWA Training Slide Deck (PDF)

HIPAA
  • HIPAA Fact Sheet (PDF)
  • HIPAA Training Slide Deck (PDF)

Universal American (UAM) Code of Conduct
  • UAM Code of Conduct (PDF)
  • Code of Conduct FAQs (PDF)
Disclaimer Information:

Medicare Complaint Form. For more information, visit Medicare.gov or Medicare's Ombudsman. (By clicking on these links you will be leaving our website).

TexanPlus® HMO is a Health plan with a Medicare contract.

You must continue to pay your Medicare Part B premium.

The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
Limitations, copayments, and restrictions may apply.
Benefits, formulary, pharmacy network, premium and/or copayment/co-insurance may change on January 1 of each year.

Plan performance Star Ratings are assessed each year and may change from one year to the next.

Medicare beneficiaries may also enroll in TexanPlus® HMO through the Centers for Medicare & Medicaid Services Online Enrollment Center, located at www.Medicare.gov (by clicking on this link you will be leaving our website).

We also list pharmacies that are in our network but are outside Austin, Brazoria, Chambers, Fort Bend, Galveston, Hardin, Harris, Jefferson, Liberty, Montgomery, Orange, and Waller counties in Texas. Please contact TexanPlus® HMO at 1-866-230-2513, 8:00 a.m. to 8:00 p.m. in your local time zone, 7 days a week, for additional information.

This information is available for free in other languages. Please contact our customer service number at 1-866-230-2513, 8:00 a.m. to 8:00 p.m. in your local time zone (TTY users call 711) 7 days a week. This document may be available in other formats such as Braille, large print or other alternate formats. This document may be available in a non-English language. For additional information, call customer service at the phone number listed above.

Esta información está disponible sin cargo en otros idiomas. Para obtener más información, comuníquese con el Servicio de Atención al Cliente al número 1-866-230-2513, de 8:00 a.m. a 8:00 p.m. en su zona horaria local (los usuarios de TTY deben llamar al 711) los 7 días de la semana.

Este documento puede estar disponible en otros formatos, como Braille, letra grande o otros formatos alternativos. Este documento puede ser disponible en un idioma no inglés. Para obtener más información, llame al servicio al cliente en el número de teléfono que aparece arriba.

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