Assisted Living Facilities who currently participate and receive Attendant Care rate enhanced payments, there will be no changes in the current reimbursement levels or methodology.

For initial enrollment into the STAR+PLUS Attendant Care Enhanced Payments program, Superior will only allow those providers that are currently participating in the DADs Attendant Compensation Rate Enhancements to participate.  This will extend only through the initial year of the program for the new STAR+PLUS Service Areas in Hidalgo & Lubbock.  Annually, Superior will send notice to Provider’s allowing to request enrollment & all current participating providers will receive an affidavit to complete and return to Superior indicating the Provider applied the enhancement funds to the compensation for direct care staff.  Each Provider’s compliance with the attendant compensation spending requirement for the reporting period will be monitored on an annual basis via the submission of the affidavit.  Compensation may include increased hourly rates, bonuses, paid holidays or additional benefits such as employer paid insurance.  In addition, providers may be audited on an as-needed basis to ensure financial records support the pass through of the enhanced funds.  Enhanced payments could potentially be recouped for those Providers who fail to pass the funds to their direct care staff.

Please ensure any claims billed with DOS 3/1/2012 forward include the amounts tied to their appropriate rate enhancement level.  As a reminder, any claims billed the lesser amount of the contracted amount, the claim will pay up to the billed charges.

I am currently reimbursed at level 20 under Superior, but DADs I am reimbursed at level 23. Which level will Superior pay after 3/1?

If I currently participate with Superior and receive rate enhancement, do I need to notify Superior the level I have with DADs?

Do I need to bill a separate line on my claim for rate enhancement?

Are there any reports we need to send to Superior for rate enhancement?

What is the process to appeal if Attendant Rate Enhancement payments were not paid or were paid at the incorrect rate?

Superior HealthPlan will review all NICU admissions delivered prior to 39 weeks to determine whether the delivery was elective or medically necessary.

If elective, we will deny the delivering physician and the facility (for both the delivery and the NICU).

We will not deny other Physicians (Anesthesisa,Neonatology) or other facilities (if the infant is transferred due to medical necessity).

If you have any questions regarding this new procedure, please contact Provider Services at 877-391-5921 (press 3).

Where: McAllen Convention Center

Link to workshop/registration:
http://www.tahch.org/TAHCH/Education_Central/StarPlusFeb2012.aspx

Join TAHC&H for a targeted workshop to answer your questions and help you piece together the puzzle!!

SCHEDULE

7:30 am: Registration Desk Opens (pre-registration is strongly recommended)

8:30 am – 11:45 am: Connecting the Dots… A Visit with Your MCO’s (Managed Care Organizations)
In this morning session each MCO will address targeted questions such as: claims processing and billing expectations, use of web portal, how agencies will receive referrals, how agencies will know which MCO the individual has chosen, what forms are required, how delegated tasks are handled, how agencies will know when the MCO has conducted a nursing assessment, authorized services and more.  Speakers: HealthSpring, Molina and Superior.  (3 clock hours HCSSA Administrators/Alternates; 3 contact hours continuing education for nurses; 3 SWCEU’s).

11:45 am – 1:00 pm: Lunch (included with your registration)

1:15-4:00 pm: Framing It Up-Regulatory Requirements in Star +Plus
TAHC&H staff will systematically review regulatory requirements related to Star +Plus service delivery followed by an experienced Star +Plus provider sharing lessons learned and describing their successful  transition from DADS service delivery requirements to the MCOs.  Rachel Hammon,  BSN, RN, Director of Clinical Practice & Regulatory Affairs, TAHC&H; Marissa Machado, Community Care Specialist, TAHC&H; Provider Name,  (2.5 clock hours HCSSA Administrators/Alternates; 2.5 contact hours continuing education for nurses; 2.5 SWCEU’s).

Beginning March 1, the Vendor Drug Program will:

• Still enroll pharmacy providers that want to provide Medicaid and CHIP services.
• Continue to manage Vendor Drug Medicaid and CHIP formularies.
• Continue to process claims for clients enrolled in fee-for-service Medicaid, the Children with Special Health Care Needs (CSHCN) Services Program, and the Kidney Health Care (KHC) Program.
• Deny claims for clients enrolled in Medicaid managed care or CHIP with National Council for Prescription Drug Programs error code “AF” (“Patient Enrolled Under Managed Care”). The name of the responsible Medicaid or CHIP health plan will be returned in “Additional Message Information” (Field 526-FQ).

MCOs should be offering pharmacy provider training sessions leading up to the March 1 transition. Pharmacy staff is encouraged to attend and learn the procedures for submitting claims, where to call for claim overrides or prior authorization assistance, and any other unique claim policies/procedures for Medicaid and CHIP clients.

Additional resources such as billing details, frequently asked questions, and information on how to identify a client’s MCO membership will be sent to pharmacies and will be available anytime at txvendordrug.com.

Please ensure claims billed for PAS services (Procedure Code S5125) are billed using taxonomy code 3747P1801X.  If you are billing for LTSS Nursing Services (Procedure Code S9123 or S9124), please ensure claims are billed using taxonomy code 251J00000X.  For claims received after 2/1/2012 with the incorrect taxonomy and deny must be resubmitted with correct taxonomy code.

If you have any questions, please contact your local Provider Relations Representative

Thank you!!

Superior HealthPlan

For more information about how to sign up with a clearinghouse to file your claims, click here. You can also file your claims directly through the secure Superior web portal.