Claims Submitted with Authorization Approved Prior to 3/1/2012

Posted 6 March 2012 by aborgmeyer & filed under newsroom, Provider News.

Claims submitted to Superior with an authorization issued by TMHP or DADs prior to 3/1/2012 with an ending date of service post 3/1/2012, Superior will honor the authorization and not deny claim due to no authorization on file.  Providers who check status of their claim online prior to claim being finalized may see the claim in a pending denial status.  Claims not finalized but are pending denial will appear under the status column “SET TO DENY”. All claims with a pending denial for no authorization will be reviewed to verify if an authorization was obtained prior to 3/1/2012 before claim is finalized. Superior will verify using a file provided by HHSC to determine if an authorization was approved prior to 3/1/2012 to ensure claims do not deny for no authorization on file.  If no authorization is found, the claim will deny for no authorization.  Claims that are finalized will show “Paid’ or ”Denied” in the status field.