Tag: Medicaid
Superior PCP Change Request Form
I didn’t know?
How was I supposed to know?
We all know it is going to happen. The PCP on the card is not yours. And know one knew.
But Superior has made it a little easier. No setting on hold.
Help the patient fill it out.
For Star Health, fax the completed form to (866) 626-6069.
For all others, fax to (866) 918-4447.
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.
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:
HHSC Extends Medicaid PEMS Revalidation
~Phil West, TMA
Health and Human Services Commission (HHSC) has provided an extension for physicians due for revalidation between Dec. 13 and May 31 through Texas Medicaid & Health Partnership’s (TMHP’s) Provider Enrollment and Management System (PEMS).
While the extension grants an additional 180 days to physicians due for revalidation between those dates, TMA advises physicians who are due for revalidation over the next six months to file online with HHSC as soon as possible.
Information for Medicaid Providers
Upcoming Changes to STAR+PLUS
Effective September 1, HHSC is transitioning contracts for the STAR+PLUS program. Below are a few resources that may help.
If you need help with….
Try…
Managed Organization Complaints.
Knowing how this transition will impact my billing.
Please reach out to the MCO to understand their billing process.
Helping your clients through the transition.
See the HHSC Star+Plus webpage for transition resources.
For any STAR+PLUS transition related issues, please contact the STAR+PLUS Go Live Inbox.
And as always, contact POET if you have any concerns.
HHSC Extends Postpartum Coverage.
Effective March 12, 2024, women enrolled in Medicaid or CHIP who are pregnant or become pregnant will be automatically enrolled for 12 months of postpartum coverage (formerly only 2 months).
Medicaid or CHIP coverage will be automatically extended to women while pregnant and still within their 12-month postpartum period if they are still residents of Texas. Coverage will be reinstated for the remainder of the 12-month postpartum period.
Superior Records Retrieval Project
It is always good to know things before they occur. But often we are scrambling for information after the fact.
NOT THIS TIME
Superior gives us a Heads Up.
Superior is requesting your cooperation in providing access to specific member records to facilitate a Risk Adjustment chart review. Risk Adjustment is the payment methodology used by CMS and HHS for Wellcare By Allwell and STAR+PLUS Medicare-Medicaid Plan.
The purpose of these chart reviews is to verify that information reported to Superior, and ultimately to CMS and HHS via claims or encounter data, includes all pertinent diagnosis codes at accurate levels of specificity.
Please Note: Superior has executed a Business Associate Agreement with both Advantmed and Datavant (formerly CIOX Health).
Advantmed and Datavant have been engaged by Superior to retrieve medical records selected as part of this chart review. Any information shared during this review will be kept in the strictest of confidence, in accordance with all applicable state and federal laws regarding the confidentiality of patient records, including current HIPAA requirements. Superior appreciates your cooperation with this and will work with you to minimize disruptions in member care.
You will have the option to submit medical records in the following ways:
- Secure email
- Fax
- FedEx
- Remote Electronic Medical Record (EMR) download
AND
- Onsite scanning performed by an Advantmed medical record technician
Tell your staff to anticipate a call or fax from Advantmed or Datavant to schedule the medical record retrieval in the upcoming weeks.
For any questions, please email [email protected]
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