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POET phones are out again!
We are in the office but once again our phones are not working. This also means we are unable to send or receive faxes.
Please feel free to contact us on our personal cell phones, if you have the number.
September 12, 2023
We apologize for the inconvenience
POET IS HAVING PHONE ISSUES AGAIN. ONLY SOME OF OUR LINES ARE WORKING.
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.
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.
Is it Posssible, Well and Sick Same Day?
Having Trouble Closing Those Gaps?
Check out these two articles from the POET InK files.
How to Code a Well Visit with a Sick Visit.
HEDIS News You Can Use
What is the Value of Benefits for Staff
Do you know the actual value of benefits offered to your staff?
Maybe you should.
Maybe your staff should.
If you have been looking for a way to calculate the value of benefits offered for your staff, here is an option found on the MGMA Community.
Just click the download button to view the spreadsheet.
The “how to” instructions are below.
It’s basic, but the employees seem to really like it.
1. Use the + to add a tab for each employee.
2. Rename each tab to your employee’s names.
3. Copy and paste the content from the ‘Employee A’ tab to the rest of your employee tabs.
4. Update the DATA INPUT tab with the amount your clinic pays for each employee on a monthly bases (this info will pull into the employee’s individual tabs).
5. In each employee tab, input the amount you pay monthly for Life Insurance (if you provide that benefit) in column B.
6. In each employee tab, modify as needed, the number of days you give for PTO, Holiday & the Retirement % (you’ll need to update both the description and also the formulas in column C).
7. Add or remove benefits as it applies to your clinic and employee.
I hope you find this to be helpful!
Connie McVein, Chief Executive Officer
Oregon Neurology, Springfield OR
UHC Network News
Do you and your staff have the UHC Prior Auth Blues?
File a Complaint
If a provider, believes a health plan isn’t complying with the dispute resolution process, then they may contact the No Surprises Help Desk at 1-800-985-3059 from 8 a.m. to 8 p.m. EST, 7 days a week, to submit a question or complaint. Or, they can submit a complaint online, below. Supporting documentation may be required. We’ll send a confirmation email to the provider when we receive their complaint to notify them of next steps and let them know if we need any additional information. To check on the status of a complaint, or to see what documentation is needed, contact the No Surprises Help Desk.
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