Superior Health Plan

Have You Seen the New, Upgraded Provider Portal?

You can now submit claim adjustments, view member gaps in coverage, and view Texas Health Steps exam dates! New features include an enhanced web authorization process and much more! To login or register click here!

Long Term Service and Support Providers (LTSS) Rate Enhancement Methodology

Effective 3/1/2012, Superior will begin to reimburse Providers the Attendant Care Rate Enhanced payment at the same participation level as they are assigned by DADs (Levels 1 – 23). Superior will include the appropriate amount within the fee schedules for the codes included in the enhancement program (PAS & DAHS) to reflect the Providers participation level and will continued to be paid at the time of claim payment. Providers who are enrolled and subsequently do not continue participation in DADs, the level will remain the same throughout the duration of their participation in the Superior program. All Providers who participate in and receive enhanced payments, performance measures will be reviewed annually to determine continued participation. Those who request enrollment including all current Participating Providers will receive notice of approval/denial of participation by Superior and level of participation. All Providers will be required to demonstrate enrollment and in good standing with the DADs program, if applicable.

NICU Admissions

Effective February 1, 2012

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).

Long Term Service and Support Providers (LTSS) Texas Association of Home Care & Hospice Workshop

When: February 28, 2012

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)

Want to Minimize Your Denials on Claims?

Check out our provider orientations for a refresher on key components of Superior’s programs, billing requirements, and common denial reasons.

March 1 for Managed Care Expansion

Beginning Thursday, March 1, 2012, Managed care organizations (MCOs) that contract with the Health and Human Services Commission will administer prescription drug benefits and payments for Medicaid managed care and Children’s Health Insurance Program (CHIP) clients. Each MCO will contract with a pharmacy benefits manager (PBM) that will process prescription claims and contract and work with pharmacies that serve CHIP and Medicaid managed care clients.

Did You Know that All Claims Require a Diagnosis Code to be Billed on up to the Highest Level of Specificity?

Superior has a guide to help you identify the appropriate diagnosis code to use on your claims. Click here for a Commonly Used Diagnosis Guide to assist you with billing your claims!

Do Your Members Need Extra Help That’s Beyond Their Health Needs?

Let Superior help you! Our MemberConnections staff can do personal outreach for members who need help with utilities, food, housing, and clothing just to name a few. Superior Provider Relations staff can connect you with a regional Connections rep to assist your members! Also, check out our Caregiver Resources page for more resources.

Long Term Service and Support Providers (LTSS) Claims Billed with Inappropriate Taxonomy Codes

Claims submitted for Personal Attendant Services (PAS) that are incorrectly billed using the taxonomy code associated to Home Health Services 251E0000X will deny EX9L – Taxonomy does not match service provided. All claims received after 2/1/2012 will deny if they are not submitted using the correct taxonomy code.

Did You Know That You Can Submit Your Claims Electronically with Superior?

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.