Tag: Fee-for-Service (FFS)
Superior HealthPlan Billing Changes
Important Provider Update
Effective September 1, 2025
The Texas Health and Human Services Commission (HHSC) will transition Medicaid-only services for dually eligible clients (eligible for both Medicare and Medicaid) from Fee-for-Service (FFS) to a Managed Care service delivery system.
Superior HealthPlan will be responsible for adjudicating these claims.
Provider Responsibilities
Submit claims for Medicaid-only services for dual eligible clients directly to the Managed Care Organization (MCO).
If a Claim is Sent to TMHP in Error:
TMHP will forward the claim to the correct MCO.
The TMHP response will only confirm forwarding – no ER&S report will be issued.
Claims with dates of service on or after Sept. 1, 2025 will not be adjudicated by TMHP.
Provider Action Steps
✅ Submit Medicaid-only service claims directly to the MCO.
✅ Contact the MCO for claim status and adjudication questions.
✅ Review the Rider 32 Procedure Code List (PDF) for impacted services.
✅ Reach out to your Provider Representative via the Find My Provider Representative webpage.
Need Help?
Contact your dedicated Provider Representative
Medicare FFS Claims: 2% Payment Adjustment (Sequestration) Changes
- No payment adjustment through March 31, 2022
- 1% payment adjustment April 1 – June 30, 2022
- 2% payment adjustment beginning July 1, 2022
Two New Files Added
COVID-19 FAQs on Medicare FFS Billing, CMS, October 6, 2021
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