Information for Healthcare Providers and Pharmacies

Welcome

Information for Healthcare Providers and Pharmacies

Thank you for visiting TexanPlus^® HMO. This site provides you helpful resources you need to better understand your patients’ coverage. Learn about the pharmacy benefits for your patient’s prescription drug coverage.

Healthcare Provider Roles and Responsibilities

In order to provide quality services to our members, it is necessary for TexanPlus and its Providers to maintain a cooperative relationship. We strongly believe in the concept of "A Healthy Collaboration^SM" with those who deliver services to TexanPlus members. To maintain open communication, we encourage Providers to direct questions and concerns to the TexanPlus Provider Relations department.

TexanPlus^® Providers Relations can be reached at: 1-800-958-2707 8:00 a.m. to 8:00 p.m. in your local time zone (TTY users call 1-800-958-2692) every day.

The TexanPlus Provider Relations staff will be able to assist in answering many questions Providers may have including but not limited to:

• Joining the network
• Knowing your network status or whether a referral you wish to make is to a TexanPlus participating Provider
• Adding or changing a facility program
• Inquiring about claims issues or concerns
• Understanding contract language and reimbursement schedule
• Asking about application Status
• Credentialing/Re-credentialing Status
• Confirming provider numbers (Unique assigned ID and Vendor numbers)
• Changing availability (i.e. extended leave, sabbatical)

Provider Resources

• Formulary Changes
• Prior Authorization Status Search
• Formulary and Prior Authorization Forms
• Provider Login
• Access information pertaining to the CMS Non-matched list
• 2010 Provider Manual
• Medicare Part D Coverage Determination Request Form
• Vaccine and Administration Claim Form
• Non-Contracted Provider Payment Dispute Instructions
• Non-contracted Provider Payment Dispute Form

Medicare Fraud, Waste and Abuse

Please view Universal American’s Medicare Advantage Part D Fraud, Waste and Abuse Training for Pharmacies and Pharmacy Staff.