December 9, 2011
Registration Open for LTSS claims Testing

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August 15, 2011
Notice: Labor Day Federal Holiday Delay in Payments

There will be a delay in payment for Medicaid, STAR+Plus, Foster Care and the Children’s Health Insurance Programs because of the Labor Day federal holiday on Monday, September 5, 2011. The next claim payment will resume on the regular cycle.

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August 5, 2011
Your Texas Benefits Medicaid Card Announcement

HHSC Rolls Out the New Your Texas Benefits Medicaid Card

The Texas Health and Human Services Commission (HHSC) is introducing a new system that uses digital technology to streamline the Medicaid eligibility verification process and provides access to Medicaid health history. The two main elements of the system are:

• The Your Texas Benefits Medicaid card, which replaces the paper Medicaid ID letter (Form 3087) that clients receive in the mail monthly.
• A website for Medicaid providers that supplies up-to-date information on a patient’s eligibility and history of services and treatments paid by Medicaid.

During the first week of August 2011, HHSC will begin mailing the Your Texas Benefit Medicaid cards to 3.4 million Texans covered by Medicaid. Medicaid clients can begin using the cards immediately. The new plastic card will be the client’s everyday Medicaid card and will only be replaced if the client changes health plans or the card is damaged or lost.

Medicaid providers can begin using www.YourTexasBenefitsCard.com to verify patient’s Medicaid eligibility. Providers can opt to purchase equipment, such as a card reader, to utilize the card’s magnetic stripe that contains the client’s Medicaid ID number. However, no equipment is required. Providers also can continue verifying eligibility through existing channels, which do not require the purchase of any additional equipment.

Additional functionality for the Your Texas Benefits Medicaid card project will roll out in late 2011. New features will:

• Allow providers to view patients’ claims, prescription, and diagnosis history; immunization details and lab data; and allow e-prescribing.
• Give Medicaid clients the ability to view eligibility information, details about services received, and Explanation of Benefits (EOBs). Clients will also be able to request a card replacement online and print a temporary card

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August 3, 2011
New Legislative Mandate for Private Duty Nursing Ratios

Dear Provider,

This is to notify you that Superior HealthPlan Network (Foster Care), will implement new Private Duty Nurse (PDN) ratios (2:1, 3:1) as mandated by the Legislature. This mandate allows for the increase in nurse to member ratio based upon the member’s health status and meeting certain criteria. Therefore, effective October 1, 2011 and thereafter, each submitted authorization request for PDN hours will be reviewed by a Service Manager for medical necessity and appropriate ratio determination. Existing members currently receiving PDN services, whose condition allows for a higher ratio, will be transitioned on the start date of the new authorization.

Criteria and billing information will be forthcoming.  Please continue checking our website for updates.

Please feel free to call us at any time should you need additional information or have a question regarding our new Private Duty Nurse (PDN) ratios. Our contact # is (866) 912-6283.

Sincerely,

Superior HealthPlan Network

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July 26, 2011
Electronic Date Interchange HIPAA Version 5010 Implementation

Superior HealthPlan will soon initiate the implementation of the Electronic Data Interchange (EDI) Version 5010 in accordance with the federal Health Insurance Portability and Accountability Act (HIPAA) rules for all EDI transactions.  HIPAA rules mandate that the implementation of EDI Version 5010 will begin January 1, 2012.  From October  1, 2011, through December 31, 2011, Superior HealthPlan will support a dual-strategy approach to the implementation of EDI HIPAA Version 5010.  Trading partners will be able to submit version 4010 transactions through December 31, 2011; however, trading partners that have passed the EDI HIPAA Version 5010 testing and certification requirements may send version 5010 transactions beginning October 1, 2011.Superior HealthPlan is working with Edifecs  to ensure a successful transition to the new formats.  Trading partners are required to complete HIPAA Version 5010 testing and certification using the Centene Edifecs Ramp Management Testing Facility.  To obtain access to the HIPAA Version 5010 Companion Guides, sample files, and FAQs trading partners must enroll on the Centene Edifecs Ramp Management site: www.centene.com/edifecsAdditional information regarding HIPAA Version 5010 will be communicated on the Centene Edifecs Ramp Management site, and distributed to trading partners that have enrolled for testing on the Centene Edifecs Ramp Management site.

Questions? Contact the EDI Helpdesk at ediba@centene.com or 1-800-225-2573 X25525.

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June 21, 2011
Notice: Fourth of July Federal Holiday

There will be a delay in all payments for Medicaid, CHIP and Foster care programs due to the Fourth of July federal holiday on Monday, July 4, 2011.