The HealthSpring Care Insights Code Program

HealthSpring has partnered with Vim to improve practices’ access to data and streamline workflows by using Vim’s Care Insights application at the point of care.

Vim’s Care Insights application integrates HealthSpring's Medicare Advantage data into the existing EHR workflow, allowing providers to identify and close care gaps more efficiently, without logging into separate portals or payer reports.

By surfacing diagnosis and quality opportunities inside the EHR, practices can complete more comprehensive assessments during each visit while ensuring more accurate documentation and coding.

HealthSpring's Prospective Program Comprehensive Assessment

The Prospective Program Comprehensive Assessment is a HealthSpring Medicare Advantage benefit designed to enhance patient care. Using Care Insights - the point of care gap presentation tool, providers can:

• Identify and document preventive care opportunities.
• Capture current conditions and treatment plans.
• Close gaps in care, improve quality metrics, and gain a full picture of the patient’s health directly within the clinical workflow, supporting both Star and risk-adjustment assessments.

Without submission of a 360 Comprehensive Assessment

• A payment of $150 will be made for an approved POC gap presentation and completed actions for all gaps with supporting medical records for the date of service.

With submission of a 360 Comprehensive Assessment

• The maximum administrative payment will be limited to the total allowable amount for the 360 Comprehensive Assessment (paper or electronic).

Please note: The information on this page is provided by HealthSpring and shared by Vim for educational and informational purposes only. Vim is not affiliated with or responsible for administering any HealthSpring's incentive programs and does not manage, calculate, or distribute payments associated with them. All incentives and bonuses are offered directly by HealthSpring in accordance with their program guidelines. 360 Comprehensive Assessments are not submitted through Vim and/or Care Insights. 

Workflow Integration

• Before the Visit: Open Vim Care Insights to review gaps and prepare for the encounter. Any insights that cannot be actioned can be dismissed with feedback sent back to HealthSpring.
• During the Visit: Address gaps in real time, document findings, and capture ICD-10 and CPT-II codes directly in the encounter.
• After the Visit: Submit a claim using your standard process — claims are not submitted through Vim, and send supporting documentation to HealthSpring. Vim updates HealthSpring on actions taken in Care Insights.

Responding to HealthSpring's Insights in Vim

Providers can interact with HealthSpring directly using Care Insights by selecting:

1. Agree - Confirms an insight is being acknowledged and addressed appropriately. If any additional documentation is needed in the EHR, it should be handled by the user.
2. Agree & Select - Confirms an insight is being acknowledged, addressed and coded appropriately with ICD or CPT codes. If any additional documentation is needed in the EHR, it should be handled by the user.
3. Dismiss – Records a dismissal reason for feedback when an insight cannot be actioned.

Submitting Gap-Closure Documentation with Vim

Providers can use Care Insights to streamline the submission of gaps, but it is important to note that submitting codes through Care Insights does not replace the requirement to submit medical records directly to HealthSpring.

Option 1: Continue submitting Comprehensive Assessments through your current process with no administrative changes. 

Option 2: Submit via electronic transmission through Vim to HealthSpring by enabling Clinical Data Exchange (CDE) on the Vim platform. 

Option 3: Submit medical records directly to HealthSpring. Fax to 860.907.0235 or email VIMproviderfax@HealthSpring.com.

Questions & Support

Contact your HealthSpring representative. Learn more here.