tracelogoRB Reference Guide for the HTA Focus Plan

 

Contract Effective Date: 1/1/2019

 

 

The HTA Focus Plan, administered by Centivo, is a new health plan serving Cone Health employees and their families.

 

The Focus Plan network is built exclusively around Triad HealthCare Network (THN) which includes Cone Health facilities and physician practices as well as a large number of independent and community physicians.

 

This Quick Reference Guide provides information specific to the HTA Focus Plan concerning claims, members, and policies.

 

 

General Information

Eligibility/Benefits


Referrals from PCP Required

HTA Focus Plan ID Cards

Claims Submission

Claims Inquiries

Provider Relations

 



General Information

 

 

The Focus Plan involves coordinated care and uncoordinated care.

  1. "Coordinated Care" refers to care provided to Members who have designated a primary care provider and received referrals for specialty and ancillary care.  For Coordinated Care, there is a $30 co-pay.

  2. "Uncoordinated Care" refers to care provided to Members who do not designate a primary care provider or who do not get referrals before seeing a specialist.  These services are covered at a reduced level and are subject to a deductible and 40% co-insurance.

 

Please do not send claims directly to the HTA Focus Plan.  All HTA Focus Plan claims must be sent to HNS.

 

Please ignore the claims billing address on the member ID card or any address given to you on the telephone when verifying eligibility and benefits. You are under contract as a participating HTA Focus Plan provider through HNS, and our instructions for filing claims supersede information given to you by HTA Focus Plan Representatives!

 

If you have any questions about the HTA Focus Plan, please contact your HNS Service Representative at (877) 426-2411 before calling the HTA Focus Plan.

 

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Eligibility/Benefits

 

Be sure to ALWAYS verify eligibility for each HTA Focus Plan member! 

 

Physical therapy services require pre-authorization!  To obtain pre-authorization, call (833)-576-6491 or email to This email address is being protected from spambots. You need JavaScript enabled to view it.

 

To verify eligibility and benefits, refer to the telephone number on the member's identification card or call Centivo Support at (833) 576-6491.

 

Please remember to ask for specific information on chiropractic benefits for each member. CLICK HERE to see a sample Verification of Eligibility/Benefit Form.  

  

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Referrals from PCP Required

 

With the HTA Focus Plan, it is the responsibility of the member to designate his/her PCP and then to obtain a specialist referral from the PCP, and to submit that referral to Centivo prior to the specialist appointment.

 

Provided the member designated his/her PCP, and provided the member obtained and submitted the PCP referral to Centivo, a $30 copay will apply.

 

IF the member did not register a PCP or obtain and submit a referral from the PCP to Centivo, the plan will pay 40%, subject to a deductible ($500/individual and $1000/family).

 

To determine whether the member obtained and reported the referral to Centivo, you may call Centivo Support at (833) 576-6491.

 

Neither the name of the referring provider nor a preauthorization number is required on the claim form.

 

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HTA Focus Plan ID Cards

 


              

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Claims Submission

 

Please do not send claims directly to the HTA Focus Plan.  All HTA Focus Plan claims must be sent to HNS. (Please ignore the billing address on the member ID card or any address given to you on the telephone when verifying eligibility and benefits.)

 

At this time, ALL HTA Focus Plan claims must be submitted to HNS by paper via the CMS 1500 claim form.  This includes primary claims as well as secondary, corrected, and claims with attachments.

 

Group Number:

Cone1 is the group number for the HTA Focus Plan and must be included in Box 11 on the claim form.

 

HTA Focus Plan must be included in Box 11c on the claim form.

 

Claims must be identified as HTA Focus Plan claims in the address section at the top of the CMS 1500 claim form (HNS/Focus Plan is an acceptable format).

 

                  Example:  
                  HNS/Focus Plan
                  PO Box 2368
                  Cornelius, NC 28031 

  

Neither the name of the referring provider nor a preauthorization number is required on the claim form.

 

If you have any questions about the HTA Focus Plan, please contact your HNS Service Representative at (877) 426-2411 before calling the HTA Focus Plan.

 

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Claims Inquiries

 

To check claims status directly, email Centivo Support at the following email address:  This email address is being protected from spambots. You need JavaScript enabled to view it.. Please include all of the following information in your email: your name, your telephone number, the name of the provider, the HNS EIN, the patient's full name, subscriber ID, date of service, and billed amount.

 

For assistance from HNS on claims status, (after 60 days from your billing date), please email your HNS Service Rep and include the patient name, date of birth, member ID number and the dates of services in question. We will gladly trace the claim for you and will respond back to you within 3 business days. 

 

Resubmit lost/missing claims through HNS.

 

Refer to your HNS/HealthTeam Advantage fee schedule to confirm allowable amounts. All HNS fee schedules are located on the secure section of this website. 

 

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Provider Relations 

 

Questions relating to your participation in the HTA Focus Plan should be directed to your HNS Service Representative at (877) 426-2411. 

 

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