Superior: New Availity Claim Features and Webinars.
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Superior: Appeal Submissions
IMPORTANT: Post-Service Medical Necessity Appeal Submissions
Superior HealthPlan would like to remind providers that post-service Medical Necessity Appeals must be mailed or faxed using the submission information below. Submissions must include the reason for appeal and any additional clinical information for appeal review..
Centene Management Company
ATTN: Medical Management Appeals
5900 E. Ben White Blvd
Austin, Texas 78741
Fax number: 1-866-918-2266
Post-service appeals for reconsideration of a Medical Necessity Denial on behalf of a member should not be sent to the Claims Appeal address.
For questions about post-service Medical Necessity Appeals, providers can contact 1-877-398-9461.
Submit 2024 MIPS Data by April 14th
The data submission period for Medicare’s 2024 Merit-Based Incentive Payment System (MIPS) performance yeard has been extended to April 14th at 7 pm CT.
At Stake is a pay cut of up to 9% in the 2026 payment year.
Prior Auth for Certain Sleep Studies, No Longer Required by Superior as of April 1, 2025.
For all Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), CHIP and Ambetter from Superior HealthPlan members, Superior will no longer require prior authorization for the following Current Procedural Terminology (CPT) codes:
For Medicaid, CHIP and Ambetter members 17 years of age and younger, Superior will no longer require prior authorization for the following CPT codes:
Aetna Fee Schedule Update Effective Today
However, Aetna tells POET the fee schedule is not ready for them to send out, yet.
Cigna Medicare Business Acquisition Completed
Well, it is final. As of today, March 19, 2025 Health Care Service Corporation
(HCSC) has acquired Cigna’s Medicare operations.
HCSC has acquired Cigna’s Medicare businesses, including Medicare Advantage, Cigna Supplemental Benefits, Medicare Part D, and CareAllies.
It has been stated:
- Members will have the same plan, member ID, benefits, and network structure.
- No changes are expected for 2025
- You should not expect any changes in coverage levels or out-of-pocket cost.
- And the one we all hoped would change, BCBS says we can still expect the same level of service.
Exclusion Review (HOW TO)
Part 3 of 3: System for Award Management Report (SAMS)
This one is a little bit tricky. If you need help, please give us a call.
Exclusion Review (HOW TO)
Part 2 of 3 Exclusion Review: Texas Office of the Inspector General
Exclusion Review Part 1 of 3
Texas Office of Inspector General (OIG) Exclusions
Don’t forget to retain searches for 10 years.
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