Month: August 2023
10,000 Members Lost Medicaid Coverage
HHSC Notice: Erroneous Termination of Superior Member Coverage
A recent notice from the Texas Health and Human Services Commission (HHSC) indicated that approximately 10,000 Superior HealthPlan members incorrectly lost their Medicaid coverage after April 1, 2023. This error is currently being addressed by HHSC, and we anticipate the reinstatement of benefits for these members soon.
Requested Action for Providers
Member Reimbursements
- Should members approach you with a request for refunds due to out-of-pocket expenses made during their period of interrupted coverage, they are entitled to full reimbursement.
- It is essential that you promptly process these refunds.
- As indicated by HHSC, these members will continue to have coverage until their cases have been reviewed. Any services for these members provided during this period can be billed to Superior HealthPlan.
Prompt Claim Submission
- After processing member refunds, please submit the relevant claims to Superior immediately. This swift action is crucial to avoid denials due to timely filing.
Prompt Claim Re-Submission
- If a claim was rejected as a result of member ineligibility, please resubmit the claim for processing.
- If a denial was received and is within 95 Days of the denial date, please submit a new claim.
- If more than 95 Days have elapsed since the denial, please follow the process for submitting a reconsideration, outlined in the Claims Reconsiderations section of the Superior HealthPlan STAR, CHIP, STAR+PLUS, STAR Health and STAR Kids Provider Manual. In the reconsideration request, please indicate: Member’s eligibility retroactively reinstated.
Handling Timely Filing Denials
- If you face a denial for timely filing, please follow the process for submitting a reconsideration, outlined in the Claims Reconsiderations section of the Superior HealthPlan STAR, CHIP, STAR+PLUS, STAR Health and STAR Kids Provider Manual. In the reconsideration request, please indicate: Member’s eligibility retroactively reinstated. Please also include the following when submitting a reconsideration:
- Explanation of payment.
- Documentation showing the reimbursement provided to the member for the affected dates of service.
For additional support, queries or clarifications regarding this situation, please contact your local Account Manager.
Salary and Benefit Survey
We all need a little help from time to time.
When hiring, reviewing payroll, or adjusting pay scale, it is helpful to know the “going rates.”
You search the internet to find some great information.
However, the information is usually Houston, Dallas or Fort Worth based.
Yet, we all know Metroplex never looks like Rural.
This is where we need to join together and be a help to each other.
We ask you to please print the salary survey. Fill out as much as you feel comfortable with. Then you may fax or e-mail it to POET. If you would like to remain completely anonymous, mail it to 111 Gaslight Blvd, Ste. B, Lufkin, Tx 75904.
Your participation is important. With many offices facing the current weight of hiring, they are also looking for the local pay range. POET receives requests for local salary ranges. However, we do not have this information, unless it is provided by our members.
Again-you can participate anonymously by returning the survey by mail.
Please, help relieve the burden of stress for so many Office Managers and Administrators.
Staff Reviews, we all hate them
The opportunity for these meetings to go well is just a few measurements away. Whether it is front-desk, back-office, or healthcare staff, making sure that you have measurable goals and metrics will ensure these meetings are successful.
This article from Physicians Practice has some great pointers. Check it out by clicking the link below.
Cigna Network News 3rd Quarter 2023
Claim status notifications available on the CignaforHCP.com Message Center
7 Tips to Combat Embezzlement
Reducing medical practice embezzlement risk with cash controls
POET is having Phone Issues
If you have an emergency issue and have one of cell numbers, please use those. If not you will have to email. Sorry for the inconvenience.
Update: we are back up and running.
Your Patient’s MBI may change!
Over 47,000 Medicare Beneficiaries may been involved in a Data Breach that involved Personally Identifiable Information (PII) and/or Protected Health Information (PHI).
New Medicare Cards with a new Medicare Beneficiary Identifier (MBI) are being mailed out.
Ask Your Patients, If They Have A New Medicare Insurance Card!!
BCBS Pharmacy Quarterly Update
Changes Effective October 1, 2023
Health Plan Representatives Update 8/3/2023
The Health Plan Representative List has been updated. Feel free to download and keep a copy in all the areas where it is needed.
Recent Comments