Advantra - TX

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WELCOME PROVIDERS!

Thank you for contracting with Coventry Health Care.  Coventry Health Care provides coverage to millions of members across the country and offers products to a broad cross section of individuals, employers and government-funded groups, government agencies and other insurance carriers and plan administrators.  It is one of the nation’s largest providers of Medicare Advantage plans, offering value to Medicare beneficiaries on a local and national basis. 

We are glad you decided to partner with us in ensuring the best possible health outcomes for your patients who have chosen to become Coventry Health Care members!

  • As a Coventry contracted provider you will have access to a one-stop shop membership verification, prior authorization and claims payment research system through www.directprovider.com.  Providers have told us that this is one of the best features we have. 
  •  We can also pay you faster if you sign up for our Electronic Transfer Program which allows payments to be direct deposited into your designated provider bank account.  The form must be completed and returned to the address on the form along with a voided check if the account type is “C" checking or a deposit slip if the account type is “S” savings.


When you access this same provider website, www.directprovider.com, you will find the following important documents to help you serve our members:

  • Member ID card sample
  • Provider Manual
  • Prior Authorization List
  • Quick Reference Guide to important phone numbers, addresses, and websites
  • CMS (The Centers for Medicare & Medicaid Services) Ownership/Controlling Interest Worksheet


Currently enrolled Coventry Health Care members should be directed to www.tx.chcadvantra.com or 1-800-727-9712 (TTY/TDD 711 Telecommunications Relay Service) information about their plan benefits and general questions.

 

Clinical Practice Guidelines

Coventry adopts evidence-based clinical practice guidelines from nationally-recognized sources. These guidelines have been adopted to promote consistent application of evidence-based treatment methodologies and made available to practitioners to facilitate improvement of health care and reduce unnecessary variations in care. Coventry reviews the CPGs every two years or more frequently if national guidelines change within the two-year period.

The CPGs are provided for informational purposes only and are not intended to direct individual treatment decisions. All patient care and related decisions are the sole responsibility of providers. These guidelines do not dictate or control a provider's clinical judgment regarding the appropriate treatment of a patient in any given case.

CPGs that have been formally adopted can be accessed through the links below:

Clinical Practice Guidelines

Diabetes
American Diabetes Association (ADA) Standards of Medical Care in Diabetes- 2014
(reviewed and approved 6/14).
Coronary Artery Disease
American Heart Association/American College of Cardiology Foundation (AHA/ACCF) Prevention and Risk Reduction.

Therapy for Patients with Coronary and Other Atherosclerotic Vascular disease: 2011 Update
(reviewed and approved 6/14).

Asthma


National Heart, Lung and Blood Institute (NHLBI)-Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma Full report 2007 (reviewed and approved 6/14).
Major Depressive Disorder
American Psychiatric Association (APA ) Guideline for the Treatment of Patients with Major Depressive Disorder, Third Edition.
(reviewed and approved 3/14)
Attention-Deficit/Hyperactivity Disorder
American Academy of Pediatrics (AAP): Diagnosis, Evaluation and Treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) in Children and Adolescents, October 2011.
(reviewed and approved 3/14)


Preventive Guidelines

0 to 6 Years
PDF
Clinical preventive services and immunization schedules for girls birth to six years.

Clinical preventive services and immunization schedules for boys birth to six years.
7 to 12 Years
PDF
Clinical preventive services and immunization schedules for girls seven to twelve years.

Clinical preventive services and immunization schedules for boys seven to twelve years.
13 to 18 Years
PDF
Clinical preventive services and immunization schedules for girls thirteen to eighteen years.

Clinical preventive services and immunization schedules for boys thirteen to eighteen years.
19 to 39 Years
PDF
Clinical preventive services and immunization schedules for females nineteen to thirty-nine years.

Clinical preventive services and immunization schedules for males nineteen to thirty-nine years.
40 to 64 Years
PDF
Clinical preventive services and immunization schedules for females forty to sixty-four years.

Clinical preventive services and immunization schedules for males forty to sixty-four years.
65 and Older
PDF
Clinical preventive services and immunization schedules for females sixty-five and older.

Clinical preventive services and immunization schedules for males sixty-five and older.

direct provider

Manage all your Coventry health plan needs at our secure, one-stop, multi-functional provider portal.

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Page Last Updated: 07/29/2014
CMS Approved Date: Approved 02/08/2013
CMS Document ID: Y0022_PDPCCP_2013_4006_1202b

© Copyright 2008-2014 Coventry Health Care

Coventry Health Care is a Coordinated Care plan with a Medicare contract. First Health Part D is a Medicare-approved Part D sponsor. Enrollment in our plans depends on contract renewal.