To enroll in a Chronic Special Needs Plan (C-SNP), the Centers for Medicare & Medicaid Services (CMS) require documentation from a provider confirming one or more of the plan’s qualifying chronic conditions within 60 days of the member’s effective date. A plan carrier cannot rely on previously submitted claims or historical diagnoses alone to satisfy this requirement.
To support timely enrollment and member benefit access and compliance with CMS guidelines, providers must verify the member’s qualifying condition(s) using the 2026 C-SNP Qualification Verification Form.
Qualifying C-SNP Conditions
To qualify for a C-SNP, the member must have at least one of the following chronic conditions confirmed by a clinician:
- Cardiovascular Disease (CVD) — including cardiac arrhythmias, coronary artery disease, peripheral vascular disease, valvular heart disease
- Chronic Heart Failure (CHF)
- Diabetes Mellitus (DM)
Providers must check the appropriate boxes on the verification form to confirm the presence of qualifying condition(s).
How to Complete and Submit the Verification Form
- Print the C-SNP Qualification Verification Form.
- Have the member’s physician complete the clinical portion, including:
- Checking the qualifying condition(s) the member has
- Signing and dating the form
- Printing clinician name and credentials
- Submit the completed form using one of the following methods:
- Fax: 866-649-6822
- Email: [email protected]
- Mail: Enrollment, PO Box 3040, Spring Hill, FL 34611
If you have questions about completing the form or about C-SNP eligibility, providers can call 1-877-364-4566 (TTY: 711).
Hours: October 1st – March 31st, seven days a week, 8:00 a.m. – 8:00 p.m., and April 1st – September 30th, Monday through Friday, 8:00 a.m. – 8:00 p.m. (voicemail will be available on Saturday, Sunday, and federal holidays).
Our Process
Upon acceptance of the application, Clear Spring Health will reach out to the member’s provider to obtain the verification. Clear Spring Health has 60 days after the effective date to receive verification of the qualifying chronic condition. If the chronic conditions cannot be verified within 60 days of the effective date, the member will be automatically disenrolled.
Important Reminders
- Physician Certification Required: Only a licensed clinician may complete and sign the verification form confirming the qualifying condition(s).
- Accurate Documentation: CMS does not allow the plan to use diagnosis codes from past claims or records without provider attestation for new C-SNP enrollment verification.
- Timely Submission: Prompt submission of the completed verification helps avoid delays in plan enrollment and benefit coordination.