You may continue to use Superior’s secure web portal, Interactive Voice Response (IVR) as well as submission of 270/271 eligibility transactions through Emdeon.

A step-by-step guide for the Ramp Manager registration process can be found at www.SuperiorHealthPlan.com/RampManagerProcess.pdf.

For assistance, contact the EDI team directly at EDIBA@centene.com or 1-800-225-2573 ext. 25525.

1. Schedule a mammogram. Early detection of breast cancer is important. It is the #2 cancer killer of women. But, when diagnosed early, the 5-year survival rate is 98%.Doctors need information as soon as possible to treat any problems and help you live a long life. Sadly, many women still avoid getting a mammogram. Take 15 minutes to get a mammogram!

2. Talk to your doctor about osteoporosis. Osteoporosis is a disorder in which bones weaken and risk of fracture is increased. Hip fractures are of greatest concern because they can lead to an increased risk of death in the first 12 months after the fracture.Women over 60 with certain risk factors, like a history of smoking or a slender frame, should get a bone density screening. Women age 65 and over should get bone density testing, even if they have no other risk factors for the disease.

3. Get screened for Cervical Cancer.Early on, cervical cancer may not show signs or symptoms. That’s why it’s important to get screened. Women ages 21-64 should get a Pap test to screen for cervical cancer every three years.When found early, cervical cancer is highly treatable and associated with long survival rates.

4. Know the facts about Chlamydia. According to the Centers for Disease Control and Prevention, Chlamydia is the most commonly reported STD in the United States. Many people who have the disease don’t know it since it often has no symptoms.Left untreated, Chlamydia can impact a woman’s ability to have children. Sexually active women ages 16-24 should be screened for Chlamydia every year.

5. Tell a friend. Show you care by telling your loved ones get screened for breast cancer, cervical cancer, Chlamydia and osteoporosis. Your conversation could save a life!

Meningitis Prevention
The CDC recommends vaccinating all children ages 11-18. The preferred meningococcal vaccine for people aged 11-55 is the MCV4 vaccine, which targets four of the five strains of meningococcal diseases, according to the CDC. An older meningococcal vaccine, MPSV4, is also available and is recommended for certain children aged 2-10 who are at high risk for meningococcal diseases.

Identified below is the percentage of Superior Members who have received immunizations for meningitis, in comparison to the national HEDIS average. HEDIS is a set of standardized performance measures updated and published annually by the National Committee for Quality Assurance (NCQA). HEDIS is used to measure performance on important aspects of care and service.

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

Remember to bill Superior HealthPlan (Superior) for the administration of vaccines, even if the vaccines were obtained from the Texas Vaccines for Children Program. Billing Superior for the administration of vaccines allows us to identify immunizations administered and may reduce the onsite medical record impact on your office by HEDIS Abstractors.

Vaccination Codes
Administrative procedure codes are 90460 and 90461.
Without the modifier, codes are 90471, 90472, and 90474.
Vaccine codes are 90733 and 90734.

Call Provider Relations if you have any questions regarding meningitis vaccines.

The only acceptable claim forms are those printed in Flint OCR Red, J6983, ink. Although a copy of the CMS-1500 form can be downloaded, copies of the form cannot be used for submission of claims, since the copy may not accurately replicate the scale and OCR color of the form.

Providers are highly encouraged to submit forms electronically via our Web Portal at www.superiorhealthplan.com/providerlogin.

Once an account has been made, the bottom of the homepage will display a link “Click here to request your update online.” This link will redirect the Provider to the online form.

Effective May 1, 2013 we will have a new fax number to request prior authorizations for prescription drugs for the Advantage product.  The new fax number is 1-877-941-0480. Please ensure that you use the new number and the convenient form attached if you wish.

Prescription Drug Prior Authorization Form

If you have received “LO” claim denials prior to April 1, 2013, please contact your Provider Relations Representative within 120 days of the claim remittance date.

TOB Codes

First Digit—Type of Facility:

1 Hospital
2 Skilled nursing
3 Home health agency
7 Clinic (rural health clinic [RHC], federally qualified health center [FQHC], and renal dialysis center [RDC])
8 Special facility

Second Digit—Bill Classification (except clinics and special facilities):

1 Inpatient (including Medicare Part A)
2 Inpatient (Medicare Part B only)
3 Outpatient
4 Other (for hospital-referenced diagnostic services, for example, laboratories and X-rays)
7 Intermediate care

Second Digit—Bill Classification (clinics only):

1 Rural health
2 Hospital-based or independent renal dialysis center
3 Free standing
5 CORFs

Third Digit—Frequency:

0 Nonpayment/zero claim
1 Admit through discharge
2 Interim-first claim
3 Interim-continuing claim
4 Interim-last claim
5 Late charges-only claim
6 Adjustment of prior claim
7 Replacement of prior claim

Superior HealthPlan uses the U.S. Preventative Services Task Force (USPSTF) recommendations. The USPSTF recommends that clinicians screen all adults for tobacco use and provide tobacco cessation interventions for those who use tobacco products. The USPSTF found evidence, cited below, that brief smoking cessation interventions, which include screening, behavioral counseling (less than three minutes), and pharmacotherapy, are effective in helping smokers successfully quit and remain abstinent after one year.

Superior’s 2011 annual satisfaction survey examined smoking cessation advice, as well as use of medications and other cessation strategies. Members reported that they were advised to quit smoking 72% of the time. Of those interventions, medication options were discussed 43% of the time , and other cessation strategies, such as telephone helplines, counseling or cessation programs, were discussed 34% of the time.

There are numerous products and resources related to smoking cessation available to Superior Members. Chantix and Wellbutrin are covered benefits for STAR, STAR+PLUS and CHIP Members. In addition, smoking cessation gum, such as Nicorette, is covered under the STAR and STAR+PLUS over-the-counter mail order program. Members can also call 1-800-QUIT-NOW or visit www.smokefree.gov for anti-smoking advice and support.

For more information on approved medications and smoking cessation products, please visit the Vendor Drug Program (VDP) webpage at www.txvendordrug.com/formulary/formulary-search.asp.

For tips on how to help patients quit, see the CDC’s flier for clinicians found at http://www.superiorhealthplan.com/files/2013/02/SmokingCessation.pdf.

Citations:

1.  Fiore MC, Jaen CR, Baker TB, Bailey WC, Benowitz NL, Curry SJ, et al. Treating tobacco use and dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service; 2008. Accessed at www.surgeongeneral.gov/tobacco/ on 24 September 2008.

4. U.S. Preventive Services Task Force. Counseling to prevent tobacco use and tobacco-caused disease: recommendation statement. Rockville, MD: Agency for Healthcare Research and Quality; 2003. Accessed at http://www.uspreventiveservicestaskforce.org on 24 September 2008.