UT Southwestern
Health Systems

Provider Relations                                  Managed Care Guidelines

Table of
Contents

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Administrative Guidelines Accountable Health Plans of America, Inc.                               Admar Corp. Aetna Health, Inc. (HMO) Aetna Health Inc. (PPO) Affiliated Healthcare Amerigroup Community Care Beech Street Blue Choice Blue Cross/Blue Shield of Texas Cigna Behavioral Health, Inc. Cigna Health Plan of Texas PPO CompCare Delta Dental DentaBlue First Health Galaxy Health Network Great-West Life/One Health HealthSmart/North Texas Healthcare Network HMO Blue Texas Humana Health Plan (PPO) MedCorp Southwest, Inc. MenningerCare Systems/New Directions Behavioral Health  Methodist Hospitals of Dallas  Terminating 03/15/04 MultiPlan, Inc. National Healthcare Alliance/USC Health Services Opticare Eye Health Network PacifiCare of Texas HMO Parkland EPO Parkland Healthfirst Parkland KIDSfirst ppoNEXT/Medical Control Preferred Health Arrangement/Benefit Planners Preferred Plan ProAmerica Managed Care Provider Networks of America (ProNet) St. Vincent Medical Foundation Superior Vision Plan Texas Health Network Texas Municipal League Group Benefits Risk Pool   TRS Coordinated Care (Retirees) UniCare Insurance Company United Healthcare of Texas HMO United Healthcare of Texas PPO USA Managed Care Organization UT Select ValueOptions (Commercial) ValueOptions (Medicaid)

Monthly Memo Monthly Memo Other Resource Materials Champus/Tricare Overview Elements of a Clean Claim  - CMS 1500 Elements of a Clean Claim - UB92 Frequently Asked Questions Helpful Hints Individual Agreement Form Managed Care Training Medigap MCO Participation Roster Prompt Pay Timelines Provider Participation Requirements TDI - Texas Department of Insurance TERMINATED Managed Care Contracts TWCC Guidelines TWCC Participation Requirements

Please refer to the guideline sheet for specific details about each contract.

**Please Note: "All MCO Credentialed Faculty" refers to faculty who have successfully completed the UTSHS Credentialing Process and that also meet a managed care organization (MCO) provider criteria for participation (i.e. required hospital privileges, valid licensures, DEA, DPS). Due to the time necessary for the MCO to update their system with provider information, the provider's participation effective date with an MCO may not correspond with the UTSHS credentialing date.  Additional credentialing may be required by certain MCOs as noted on their respective guideline sheets.

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Last updated: 01/23/04