• Gynecological and Reproductive Health Benefits to Change for Texas Medicaid

    Effective for dates of services on or after January 1, 2015, some gynecological and reproductive health benefits will change for Texas Medicaid.  Procedure codes have been updated for Hysterectomy, Clitoroplasty and Vaginoplasty, Sterilization, Contraceptives and Other Provider Type and Place of Service Changes.  Prior Authorization has been updated for Vulvectomy, Salpingostomy and Ovarian Wedge Restrictions….

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  • Hepatitis C Treatment for Texas Medicaid Patients

    The Vendor Drug Program will implement a restricted Hepatitis C Virus (HCV) clinical edit on Friday, January 23, 2015. Prior authorization will be required for the following two Hepatitis C drugs: Drug Name NDC Sovaldi 400mg tablet 61958150101 Olysio 150mg capsule 59676022528   There are multiple clinical criteria to meet in order to receive the medication. Please…

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  • Improving HEDIS Rates for Diabetes

    Superior HealthPlan Providers are held accountable for the timeliness and quality of health care delivered to our diverse membership. One data set is for our diabetic Members. In 2013 (HEDIS 2014) Superior physicians met the 50th percentile in most sub-measures. Screening Superior HEDIS Rate 2013 Superior HEDIS Rate 2014 Superior’s Goal – 2014 Quality Compass…

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