Letter to Providers

April 9, 2020, 9:08 pm

Dear Providers:

Thank you for your recent response to Cox HealthPlans provider survey. We appreciate your feedback.

We are writing to address your concerns indicated in the survey that fall outside of the roles of Cox HealthPlans.

• Cerner: Cox HealthPlans doesn’t have any impact on Cerner or the services given to a Provider’s office by Cerner. Questions or concerns regarding Cerner should be directed to the Cox Health Helpdesk at 417.269.3153 for assistance.
• Cologuard: This is a covered benefit for Cox HealthPlans members; however it doesn’t apply towards the preventive benefit. Cox HealthPlans covers other alternatives to Cologuard as a part of the member’s preventive benefit such as Fecal Occult Blood Screening, offered annually  to members age 50-75; Screening Sigmoidoscopy offered one time every five years to members age 50-75; Screening Colonoscopy offered one time every ten years to member age 50-75.
• Appointment Notifications: This should be handled at the individual provider’s office. Cox HealthPlans doesn’t have access to a provider’s scheduling application.
• Online Formulary Access: The Cox HealthPlans formulary can be accessed at com for commercial business or thinkinghealthforward.com for Marketplace members.
• Provide upfront costs: A provider’s office has their contract rates with Cox HealthPlans and is able to provide an estimate to the patient based on the member’s benefits when getting eligibility through our Portal at com.
• Provider Specialty Services: Cox HealthPlans does not determine the provider specialties available within Cox Health Systems.
• Access to Provider Specialties: Cox HealthPlans does not require a referral in order for a patient to see a Specialist.
• EHR: Cox HealthPlans doesn’t manage the EHR application.
• Preventive Services for High Risk Patients: Cox HealthPlans follow ACA Preventive Guidelines which include specific ages and frequency.
• Mental Health Services: Cox HealthPlans allows a PCP copay level for Mental Health services. The Quality Improvement Committee initiative at Cox HealthPlans for the 2020 plan year is supporting Cox Health’s improvement of psychiatric services  access through their primary provider office(s) to allow quicker access to mental health providers.
• Cox Health Employee Plan: The Cox Health Employee Plan is a Self-Funded plan. Cox HealthPlans doesn’t determine the benefit structure for this plan.
• Cox HealthPlans Available Provider Resources: Cox HealthPlans offers a provider portal at com that will give you access to verify eligibility, benefit and claim information. In addition, coxhealthplans.com has access to our provider manual, pharmacy formularies, provider directories and necessary forms such as authorization forms.
• Claims Processing Turn Around Times: Cox HealthPlans complies with Missouri Statute Section 376.383 and Section 376.384, which states that all electronically submitted clean claims shall be processed within 45 calendar days.  Cox HealthPlans turn- around time on electronically submitted clean claims for 2019 was 18 days.  Cox HealthPlans turn- around time on electronically submitted clean claims for first quarter 2020 was 15 days. A clean paper claim submitted to Cox HealthPlans in 2019 had a turn- around time of  29 days.  A clean paper claim submitted to Cox HealthPlans in first quarter 2020 had a turn- around time of  29 days.

We hope you will find the information provided as useful. If you have additional questions you may contact Cox HealthPlans Provider Services department at 417.269.2900 option 5.