• Provider Manual
• Provider newsletters
• Superior news and updates
• Preferred Drug List (PDL) and pharmacy information
• Forms, helpful links, FAQ’s
• Information on Superior’s quality program
• HEDIS Program information and data collection process
• Member rights and responsibilities
• Practice guidelines

If you would like a printed copy of the Provider Manual, Provider newsletters or any document found on our website, please call Provider Services at 1-877-391-5921.

This process is only applicable for situations in which a TPI was not yet provided by TMHP or was temporarily removed from the Medicaid Master Provider File. Billing with an incorrect TPI and/or related taxonomy or other unrelated denials are not subject to this automatic reprocessing of claims.

It remains critical that Providers attest their TPI’s in a timely manner, and verify that their billing information matches their TMHP information to ensure accurate payment.

You do not have to appeal or submit corrected claims for MA denials in these specific instances. In this new process, Superior will automatically reprocess impacted claims up to eight months old based on initial adjudication date. These reprocessed claims will show up on your EOPs in same fashion as other reprocessed claims. There will be no special indication they are part of an automated reprocessing, and it will continue to be the responsibility of the Provider to ensure any claims initially denied due to lack of a valid TPI are reconciled appropriately.

Please call Provider Relations if you have any questions

Identified below is the percentage of Superior Members who have received a retinal eye exam, in comparison to the national HEDIS average.

*The National HEDIS Average is the average of all HMOs that report HEDIS results nationwide.  Source: NCQA 2012 Quality Compass, National-HMO Average Rate.

Our vision vendors support these efforts by contacting Members in need of retinal eye exams to assist them in scheduling appointments.

If you have patients with diabetes, Superior can assist your office with finding a vision Provider for those Members. Call Provider Relations to find vision Providers in your area.

If any information gathered as part of the primary source verification process differs from data submitted by the practitioner on the credentialing application, Superior will notify the practitioner and request clarification.

The information may be released to practitioners only after a written and signed request has been submitted to the Credentialing Department. Providers also have the right to request the status of their credentialing or recredentialing application at any time.

Contact Superior’s Credentialing Department at 1-800-820-5686 or Credentialing@Centene.com.

• The lists of services requiring prior authorization have been revised and should be utilized for Advantage by Superior HealthPlan members. The revised lists for Medicare Part B Medications and Medicare Prior Auth Requirements can be found at http://www.superiorhealthplan.com/for-providers/advantage-providers/.
• A fax line has been established for Advantage by Superior Healthplan prior authorization requests. Effective July 1, 2013, please fax all prior authorization requests to 1-877-808-9368.

We are confident that this change to the prior authorization process will allow us to provide better service to both you and Advantage by Superior HealthPlan members. Thank you for your cooperation in making this change to your prior authorization contact information.

If you have additional questions, please contact the Prior Authorization department at 1-800-218-7508.

The Texas Health and Human Services Commission (HHSC) defines a migrant farm worker as “a migratory agricultural worker, whose principal employment is in agriculture on a seasonal basis, who has been so employed within the last twenty-four months, and who establishes for the purposes of such employment a temporary abode.”

Migrant families can encounter many barriers in obtaining health care services for their children, especially during the travel season for the family. Superior is committed to reducing these barriers for the family. We ask Superior Providers to assist in our efforts by identifying Members as migrant farm workers, and providing preventative checkups before the family must travel for work, which may be earlier than the periodicity schedule of exams dictates.

If you become aware of a Superior Member who is a migrant farm worker or the child of a migrant farm worker, please notify Superior by calling 1-800-783-5386.

Please have the Member call that number as well. Superior can assess the child’s health care needs, provide education about the services available, and arrange appointments and transportation.

If you have questions about migrant farm workers, please call Superior at 1-800-783-5386.

To ensure ongoing communication with Superior, Physicians and other Providers must register all current and/or updated email addresses with Superior at www.superiorhealthplan.com/newsflash.

As a reminder, Superior offers a number of useful online services and documents through its secure web portal located at http://www.superiorhealthplan.com/providerlogin/.

Online services on the Secure Portal include member eligibility verification, Primary Care Provider (PCP) Member panel lists, claims status verifications, prior authorization submission requests, and requests for provider demographic changes.

If your practice prefers to continue receiving written communications, please fill out a Paper Communication Request Form and submit to:

Superior HealthPlan
Attn: Provider Relations
2100 South IH-35, Suite 200
Austin, TX  78704

If you have questions about paperless communications or need additional information, please contact Superior Provider Relations at 1-877-391-5921.