Provider FAQ
- 1. What happened to Clear Spring Health (CSH)?
Clear Spring Health has made a strategic decision to exit the Medicare Advantage Prescription Drug (MAPD) business in all states where it operates. Clear Spring Health is actively reaching out to members, providers, and agents to ensure a smooth transition.
- 2. What is the official termination date for members’ healthcare coverage?
Midnight of May 31, 2026.
- 3. Will Clear Spring Health pay all claims that weren’t paid over the last few months and until the termination date?
CSH will pay all claims for services rendered until May 31, 2026, at midnight, following the same criteria used before the closure announcement.
- 4. When will my members/patients be notified?
Members will be notified by mail between May 6th and May 11th, depending on their location. Members will begin receiving calls on Wednesday, May 6th.
- 5. How will continuity of care be addressed?
The receiving MA plan must honor all active care plans for 90 days, even if the provider is out-of-network. If a provider is not in network with the new MA plan, submitting a prior authorization request supported by medical records outlining the care plan and any prior CSH authorizations should suffice. The receiving plan is obligated only to pay standard Medicare rates. Contact the beneficiaries’ new plan for more information.
- 6. What is the run-out period for claims submission?
Timely filing deadlines will not change. CSH will process all claims filed within 365 days of the date of service. There will be no extensions for the period of downtime our systems experienced in March and April.
- 7. After the termination, how will denied and pended claims be handled?
Denied and pended claims will continue to be handled as they are now. Staff to handle appeals and reconsiderations will continue to provide these services until regulatory deadlines have passed.
- 8. Are provider contracts terminated immediately or over a run-out period?
All provider contracts will be terminated on May 31, 2026, at midnight.
- 9. Are there any provisions prohibiting providers from balance-billing members?
All terms of your contract with CSH will remain in effect for all services rendered until May 31, 2026, at midnight. This includes provisions prohibiting balance billing by network and non-network providers subject to a single-case agreement (SCA).
- 10. How will prior authorizations for care not yet rendered be handled?
Existing prior authorizations for care that hasn’t occurred will be rendered unnecessary for patients transitioning to FFS Medicare. For members transitioning to a new MA plan during the special enrollment period, a new prior authorization request will be needed.
- 11. Who will take over ongoing case management and care treatment plans?
For members transitioning to traditional Medicare, these functions will be handled by the primary care physician. For those choosing another MA plan during the special enrollment period, care management will be transferred to that plan. Continuation of care plans in flight will be honored by the new MA carrier for at least 90 days.
- 12. To whom should providers reach out for escalation of post-termination?