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Medicare Plans Referrals Required AARP Medicare Complete AARP Insurance Sheet Commercial Medicare Plans Referrals Required If the Third Party Administrator uses one of AARP Medicare Complete AARP Medicare Complete Plan H4514-007 these networks, we can see the patient Aetna Medicare Aetna Select Access Direct BCBS HealthSelect Medicare Aetna HMO BCBS Medicare Advantage PPO & HMO (Carrell, TOA, AOSM Aetna bill/auth legacy grp) Austin State Hospital BCBS HealthSelect (formerly with UHC) - (Carrell, TOA, BCBS (Carrell, TOA, AOSM bill/auth legacy grp) Cigna Medicare Advantage AOSM bill/auth legacy grp) BCBS COA Blue Essentials (formerly with UHC) - (Carrell, BeechStreet (multiplan) Connected Senior Care Advantage Aetna (Austin) TOA, AOSM bill/auth legacy grp) BCBS TRS ActiveCare Blue Essentials (formerly w/Aetna) - Cigna Connected Senior Care Advantage Humana (Austin) (Carrell, TOA, AOSM bill/auth legacy grp) Blue Essentials (formerly HMO Blue) - (Carrell, TOA, AOSM Coventry/First Health Commercial Connected Senior Care Advantage WellCare (Austin) bill/auth legacy grp) Custom Ink Friday Health Plan Medicare Advantage Cigna HMO (written from PCP) Decent Healthcare Humana Medicare Humana HMOx Fairprice Network Medicare DME Jurisdiction A, B, C and D Humana Medicare Gold Plus HMO First Care (Scott & White) Medicare Novitas Solutions Texas Free Market (requires voucher) Molina Medicare Replacement and Dual -OLS pending, bill First Health and auth legacy group Texas Workforce Commission (DARS) (purchase order) Tricare Prime and Direct Care - Note: confirming existing Friday Health Plan Oscar Medicare Advantage providers for Prime Galaxy Health Network Railroad Medicare Triwest (includes Veteran's Choice) GPA/Texas MedClinic (their employees only) Scott and White Medicare UHC Medicare Adv Referral Required Plans Healthcare Highways Superior Wellcare UHC Nexus ACO Referral Require Healthsmart Complete (new plan to market 6/2021) UHC Community Plan Dual Complete WellMed UHC Dual Complete Focus Humana UHC Medicare Advantage Careworks/Sedgewick Integrated Medical Systems UHC Medicare Solutions (fka Secure Horizons) Corvel Kelsey Seybold (specific Houston providers) UHC West Medicare Solutions (fka Pacificare) Coventry Mediview (Austin only) USA Care Medicare Replacement IMO Multiplan WellMed AARP Medicare Replacement Political Subdivision Alliance Oscar WellMed Amerivantage Mcare Repl and Dual (Amerigrp) Prime Health PHCS WellMed Humana Mcare Gold Plus HMO Texas Mutual Point Comfort Underwriters (Refugees) WellMed UHC Dual Complete Focus US Department of Labor Scott and White HealthPlan Seton Health Plan Medicaid Plans OLS Not Contracted Surgery Plus (Employer Direct Healthcare) Aetna Better Health Medicaid Amerigroup Tricare - including Tricare Prime BCBS Medicaid (Austin only) Amerivantage Mcare Repl and Dual Coordination United Healthcare Cigna Medicaid BCBS HMO Blue Advantage Exchange US Family Health Plan Dell Children's Health Plan (formerly Seton) Bright Health USA Managed Care Org/Student Assurance Molina Healthplan -OLS pending, bill and auth legacy grp Care N Care (Medicare Adv.) Superior/Superior Chip (existing patients only) Christus Health Plan Exchange Plans TMHP (Traditional Medicaid) Indigent County Humana Austin HMOx UHC Community Plan Star Plus Medicaid CSHCN & Healthy Woman (Perinate) Humana POS MedPartners Molina Healthcare -OLS pending, bill and auth legacy grp Workers Comp Networks OccuNet Provider Alliance Oscar HealthPlan AIG - Coventry* via AIG HCN Principal Edge Network Sendero IdealCare Blackstone Network (DFW only) Seton MAP (Austin only) Superior Ambetter Broadspire - Coventry* via Coventry HCN Three Rivers Careworks/Sedgewick Pending CNA - Coventry* via Coventry HCN Cook Children's Health Plan CCMSI - via IMO network or non-network Will See With Out of Network Authorization Global Health of TX (Medicare Adv.) Chartis - Coventry** Cigna HMO Out of State Crime Victims - must have case number and doctor approval Imperial Medicare Advantage Corvel to be seen (Austin) Medicaid plans pending TPIs Coventry* via Coventry HCN Medicare DME PTANs actively coming in ESIS - Coventry* via Coventry HCN Gallagher Bassett - Coventry* via Coventry OR First Health Memorial Health (Houston only) HCN depending on employer Molina Hartford - Coventry* via First Health HCN Paradigm Workers Comp Network HEB (Salus Workers Comp) Parkland Community Health Plan IMO (Injury Management Organization) Partners Direct Health Liberty Mutual - Coventry* via Liberty HCN Tx Children's Health Plan My Texas Direct/504 & DISD 504 Network (DFW only) Texas Independence Health Plan (Medicare Adv.) Nexcaliber Healthsmart Political Subdivision Alliance As of 4/26/2021 Healthsmart Accel Prime Health Service Lloyds - Coventry** Texas Mutual Travelers - Coventry* via Travelers HCN US Department of Labor Zenith - Coventry** Zurich - Coventry* via Coventry HCN *Coventry has multiple Workers Comp Networks (HCNs) each with different protocols for provider nomination & participation. Check individual provider list (coming soon from Coventry). **Coventry is confirming which network this plan accesses.
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