Information for Providers
Part D Prescription Drug Plan Transition Policy for Providers
2009 Humana Pharmacy Provider Manual
2009 CarePlus Supplement Pharmacy Manual
2010 CarePlus Provider Manual
2010 CarePlus Facility Manual
Provider Connection Newsletter
Fraud, Waste and Abuse
CarePlus Health Plans, Inc.'s Efforts to Prevent and Detect Fraud
As part of our efforts to improve the health care system, CarePlus has made a commitment to detecting and preventing fraud, waste and abuse. Success in this effort is essential to maintaining a health care system that is affordable for everyone. CarePlus is working to educate physicians and other health care providers about fraud, waste and abuse prevention.
Principles of Business Ethics
We have posted the Principles of Business Ethics (PBE) here as a resource for fraud, waste and abuse prevention education. We invite providers to review this information as soon as possible.
Principles of Business Ethics
Fraud, Waste and Abuse Prevention Training Guide
CarePlus is providing the Fraud, Waste and Abuse Prevention Training Guide,as a resource for meeting the CMS requirement that contracted entities provide fraud, waste and abuse prevention training to their employees who administer or deliver Medicare benefits or services.
Fraud, Waste and Abuse Prevention Training Guide
Special Needs Plans (SNP)
If you are currently a CarePlus Health Plans, Inc.'s provider and have any questions with regards to SNP, please contact your CarePlus Health Plans, Inc.'s Account Representative or e-mail us at CPHP_SNPInfo@CarePlus-HP.com.
It is important for Primary Care Physicians (PCPs), specialists, and other health care providers to understand SNPs and the responsibilities they have for their CarePlus-covered SNPs patients. Please, click the links provided below, so you can view Part 1 and Part 2 of the provider’s educational presentations.
CarePlus SNP Provider Education Part 1: SNP History and CarePlus Plans
CarePlus SNP Provider Education Part 2: Model of Care and Physician Roles
CareNeeds (HMO) Special Needs Plan (SNP) Benefit Overview
There are two types of CarePlus Health Plans, Inc.'s CareNeeds (HMO) plans, as shown below. Members enrolled in CareNeeds (HMO) benefit plans are dually eligible for Medicare and Medicaid. Therefore, it is important that you as a participating provider integrate these program benefits. For your convenience, we have included below our member documents, the "Standard CareNeeds (HMO) Plans" and the "Full CareNeeds (HMO) Plans [045, 046, 047, 048, 049, 050]" Overviews. These documents offer a comparison of the covered benefits offered by the plan and the benefits covered by the state's Medicaid Program that will help you become more acquainted with the new plan benefits. We encourage you to review the documents below and share them with your employees to ensure services are seamless across all programs.
Standard CareNeeds (HMO) Plans
The member must be eligible for Medicare and also eligible for full or partial levels of assistance from the state's Medicaid Program.
Standard CareNeeds (HMO) Plans- English version
Standard CareNeeds (HMO) Plans- Spanish version
Full CareNeeds (HMO) Plans [045, 046, 047, 048, 049, 050]
The member must be eligible for Medicare and also eligible for full levels of assistance from the state's Medicaid Program.
Full Dual CareNeeds (HMO) Plans [045, 046, 047, 048, 049, 050] Plans- English version
Full Dual CareNeeds (HMO) Plans [045, 046, 047, 048, 049, 050] Plans- Spanish version
Culturally and Linguistically Resources
CarePlus Health Plans, Inc. recognizes cultural differences and the influence that race, ethnicity, language and socioeconomic status have on the health care experience and health outcomes. We are committed to developing strategies that eliminate health disparities and address gaps in care. Please refer to the below document for detail information:
CPHP Gaps in Care Providers
Multilingual Healthcare Resources
Learn about CarePlus Health Plans, Inc.'s multilingual health resources for health care providers and access to helpful links. We invite providers to review the information provided in the document below:
CPHP Multilingual Health Resources
Learn more about CarePlus Health Plans, Inc.’s Medicare Advantage HMO plans by calling: 1-800-793-9808. We are open Monday through Friday, 8:00 a.m. to 8:00 p.m. From March 2, 2010, until the following Annual Election Period (AEP), you may leave us a voice mail message after-hours, Saturdays, Sundays, and holidays, and we will return your call the next business day. TTY number for the hearing and speech impaired, call: 1-877-245-7930.
This Website is for individual Medicare coverage only.
CarePlus Health Plans, Inc. is a Medicare Advantage Organization with a Medicare contract. You must be enrolled in Medicare Part B and entitled to Part A. You must reside in the service area of the Plan. You must continue to pay your Medicare Part B premium, if not otherwise paid for under Medicaid or by another third party. Some limitations, restrictions, coinsurance, and copayments may apply.
For Access to Exceptions, Grievance, Appeals, and Coverage Determinations/Redeterminations Information , please see our Forms page.
The documents that appear in this website are available in alternate format.
Click here if you have problems viewing documents on this website.
The information in these pages is accurate as of 1/1/2010, and is subject to change without notice.
CMS: H1019_CPHP_2008_Website REV 10 (APVD 03/11/10)
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