Managed Care Organizations

Please Note: This is a general overview and may be subject to change.

Managed Care Organization Commercial HMO Exchange Work Comp Medicare Medicaid Notes
Aetna Healthcare HMO, PPO, EPO, THR EPO *Narrow Network selected by network cannot opt in MA-HMO, MA-PPO, Prime MA CHIP, KIDS, STAR Must select one service area – DFW, Houston, or Austin
American Health Plan of TX I-SNP
AmeriGroup


MA-HMO, MA-SNP CHIP, DUAL, KIDS, STAR, STAR+PLUS
BlueCross & BlueShield of Texas


HMO, HME, PPO, POS, Premier BAV MA-PPO, MA-HMO CHIP, KIDS, STAR, STAR PLUS Administers TriWest and network is closed unless you have an active patient
Care N Care


MA-HMO MA-PPO
CareWorks NWI, WC
ChoiceCare – Humana PPO MA-HMO MA-PFFS MA-PPO
CIGNA HealthCare of Texas


HMO, POS, OAP, PPO, Choice Fund IFP Connect Exchange MA-HMO MA-PPO STAR PLUS LocalPlus Narrow Network closed to new Tax IDs
Cook Children’s Health Plan CHIP, KIDS, STAR
CorVel Healthcare, Inc. AUTO, NWI, WC
First Health PPO
EVRY PPO
Galaxy Health Network MSC, PPO, NWI
GlobalHealth Texas Lonestar
GlobalHealth
HMO, HMO C-SNP, HMO D-SNP, HMO-POS
HealthCare Highways PPO
HealthSmart Preferred Care, Inc. ACCEL, GEPO, HP, PPO WC
Imagine Health EPN PPO
Imperial Insurance Co, of TX MA
Independent Medical Systems PPO
LoneStar Athletic Injury Network PPO
Molina Healthcare of Texas


EXCHANGE MA CHIP, DUAL, STAR, STAR PLUS
MultiPlan PPO Med Adv Wrap Supplemental
National Preferred Provider Network (NPPN) PPO
Nexcaliber PPO
Oscar Insurance Co. of TX EPO
PHCS (MultiPlan) PPO
Prime Health Services, Inc. GH AUTO, IME, WC
Procura/Optum Federal WC, WC, AUTO
Provider Select PPO
Provider Partners Health Plan I-SNP
Scott & White HealthPlan


HMO, PPO MA-HMO MA-PPO No Exchange Plan, No Baylor Quality Alliance Plans
Superior HealthPlan AMBETTER, VALUE CHIP, DUAL, FC STAR, STAR PLUS
The Reny Company WC
Three Rivers Provider Network PPO WC
TRICARE (Humana Military Healthcare Services) Prime, 4Life
United Healthcare


HMO, EPO, OA, POS, PPO MA HMO MA PPO MA SNP CHIP, DUAL, SNP, KIDS, STAR, STAR PLUS *NOTE: Contracting is completed directly – we handle the credentialing only. Visit UHCprovider.com for more details
USA Managed Care Organization PPO WC
WellCare of Texas, Inc. MA-HMO Includes Texan Plus and Allwell
Legend
CHIP = Children’s Health Insurance Plan
DUAL = Star Plus (Medicare/Medicare)
EPO/EPN = Exclusive Provider Organization
FC = Foster Care Medicaid Program
GEPO = Gatekeeper Exclusive Provider Organization
GH = Group Health
HMO = Health Maintenance Organization
HPO = Health Payors
KIDS = Star Kids Product
MA = Medicare Advantage
MSC = Medical Savings Card (Discount Card)
NWI = Nonsubscriber Work Injury
POS = Point of Service Plan
PPO = Preferred Provider Organization
OA = Open Access Plan
SNP = Special Needs Program
WC = Workers Comp