Provider Resources
Superior HealthPlan provides the tools and support you need to deliver the best quality of care. Please view information in this section that covers forms, guidelines and helpful links.
Ambetter Providers Click For More Information (Health Insurance Marketplace)
- Allwell Qualified Medicare Beneficiaries FAQ (PDF)
- Balance Billing: Superior Medicaid and CHIP (PDF)
- Balance Billing: Allwell from Superior HealthPlan and STAR+PLUS MMP (PDF)
- Standardized Durable Medical Equipment (DME) Listing (PDF)
- TurningPoint – Procedure Coding and Medical Policy Information (PDF)
- EVV FAQ (PDF)
- EVV Provider Compliance Plan (PDF)
- EVV Provider Training (PDF)
- HHSC EVV Contact Information Matrix (PDF)
- HHSC EVV Provider Stakeholder Presentation (PDF)
- HHSC EVV Reason Code FAQ (PDF)
- HHSC EVV Reason Code Scenarios (PDF)
- HHSC EVV Aggregator and EVV Portal Webinar (PDF)
- HHSC EVV Mobile Application Policy (PDF)
- HHSC EVV Visit Maintenance Unlock Request Form (Excel)
- HHSC EVV Visit Maintenance Unlock Request Policy (PDF)
- HHSC EVV Usage, Reason Codes, Required Free Text and Allowable Phone Identification Policies (PDF)
- HHSC EVV Billing and Claims Policies (PDF)
- HHSC EVV Training, Vendor Selection, Vendor Transfer and Data Elements Policies (PDF)
- HHSC EVV Standard Reports Policy (PDF)
- HHSC EVV Tool Kit - EVV Visit Maintenance and Transactions (PDF)
- HHSC EVV Tool Kit Module 1 - Introduction to EVV (PDF)
- HHSC EVV Tool Kit Module 2 - EVV Roles and Responsibilities (Part 1) (PDF)
- HHSC EVV Tool Kit Module 3 - EVV Roles and Responsibilities (Part 2) (PDF)
- HHSC EVV Tool Kit Module 4 - EVV Visit Transactions (PDF)
- HHSC EVV Tool Kit Module 5 - EVV Visit Maintenance (PDF)
- HHSC EVV Tool Kit Module 6 - EVV Process Flow (PDF)
- HHSC EVV Tool Kit Module 7 - EVV Aggregator and Portal (PDF)
- HHSC EVV Tool Kit Module 8 - Submitting an EVV Claim (PDF)
- HHSC EVV Tool Kit Module 9 - EVV Portal Standard Reports and Search Tools (PDF)
- HHSC EVV Tool Kit Module 10 - EVV Visit Transaction Validation Enhancements (PDF)
- HHSC EVV Tool Kit Module 11 - Summary of EVV Changes (Part 1) (PDF)
- HHSC EVV Tool Kit Module 12 - Getting Started - Next Steps (PDF)
- HHSC EVV Tool Kit Module 13 - EVV Training Requirements (PDF)
- HHSC EVV Tool Kit Module 14 - EVV Compliance Oversight Policies (PDF)
- HHSC EVV Tool Kit Module 15 - Best Practices to Avoid EVV Claim Mismatches
- TMHP EDI Companion Guides
- TMHP Electronic Visit Verification (EVV) FAQ (PDF)
- For the most recent EVV updates, please visit EVV News and Announcements
Superior HealthPlan has selected National Imaging Associates, Inc. (NIA) to provide radiology network management services. NIA manages the prior authorizations for non-emergent, advanced, outpatient imaging services rendered to Superior HealthPlan members.
- NIA: High Tech Imaging QRG for Rendering Facilities (PDF) – Changes Effective 2/1/2014
- NIA: High Tech Imaging QRG for Ordering Physicians (PDF) – Changes Effective 2/1/2014
Superior HealthPlan operates a toll-free nurse hotline that providers and members can call 24-hours-a-day, 7 days a week. The hotline is staffed with nurses who are knowledgeable about Medicaid and CHIP benefits and services. The nurses can respond to calls from providers and members seeking clinical information, guidance on specialty referrals or requests for specialty provider consultations. Nurses also have access to an on-call licensed behavioral health clinician 24-hours-a-day who can assist with crisis calls.
- Prior Authorization List (PDF)
- Drugs of Abuse and Genetic/Molecular Diagnostic Testing Prior Authorization Notice (PDF)
- Drugs of Abuse Prior Authorization Code List (PDF)
- Discharge Planning Instructions (PDF)
- Preferred DME Supplier (Medline) FAQ (PDF)
- Preferred DME Supplier (Medline) Supplies Available without Prior Authorization List (PDF)
- Skilled Nursing Requirements Checklist (PDF)
- Quality Improvement resources have moved, please visit Superior's QI Program.
- Acute Care and Hospitals Quick Reference Guide (PDF)
- Allwell from Superior HealthPlan Quick Reference Guide (PDF)
- Centers for Medicare & Medicaid Services Website Resources (PDF)
- FQHC Payment Process Quick Reference Guide (PDF)
- FQHC Frequently Asked Questions (PDF)
- HEDIS Guidelines for Monitoring for Patients on Persistent Medications (PDF)
- PCP Quick Reference Guide (PDF)
- Texas Health Steps Quick Reference Guide (PDF)
- STAR+PLUS Long-Term Services (LTSS) and Supports Rate Guide (PDF)
- STAR+PLUS LTSS Quick Reference Guide (PDF)
- STAR+PLUS MMP Quick Reference Guide (PDF)
- Superior Pharmacy Quick Reference Guide (PDF)
- STAR Health Important Contacts (PDF)
- Clinical Practice Standards for Therapy Documentation (PDF)
- Early Childhood Intervention - Individualized Family Service Plan Information (PDF)
- Initial Evaluation Request for Therapy - Supplemental Information (PDF)
- Requirements For Therapy Authorization Checklist (PDF)
- Prior Authorization Therapy Documentation Provider Training (YouTube)
- Therapy Fee Schedule for Comprehensive Outpatient Rehabilitation Facility (Effective 9/1/17) (PDF)
- Therapy Fee Schedule for Home Health (Effective 9/1/17) (PDF)
- Therapy Fee Schedule for Individual Therapist Group (Effective 9/1/17) (PDF)
- HHS Provider Notice: Texas Health Steps Document Improvement (PDF)
- Texas Health Steps Clinical Record Review Tool (PDF)
- Texas Health Steps Clinical Record Review Tool and Instructions
- Texas Health Steps Online Provider Education
- Texas Health Steps Periodicity Schedule
- Texas Health Steps Regional Provider Relations Representatives Contact List
- Texas Health Steps Quick Reference Guide (PDF)
For the most updated information or to re-enroll, please visit TMHP.com.
- 3 in 30 Provider Resources
- Early Childhood Intervention (ECI) Program Information (PDF)
- Frequently Asked Questions for Prescription Drug Benefits (PDF)
- Guidelines on After Hours Telephone Accessibility (PDF)
- National Kidney Foundation - Chronic Kidney Disease (CKD) Risk Assessment Tool (PDF)
- HHSC Policy Clarification: Span of Coverage (PDF)
- Prenatal Screening for Domestic Violence and Substance Use
- Signing up for EFT through PaySpan (PDF)
- Texas Health and Human Services Provider Fraud Notice (PDF)
- The Attorney General of Texas Initiative – Combatting Sexual Exploitation (Human Trafficking)