Texas Medicaid & Health Insurance Provider Resources
Superior HealthPlan equips each of our Medicaid providers with the most up-to-date Texas provider resources available. Our resources for Texas Medicaid providers within the Superior Network includes the tools and support you need to deliver the best quality of care. Links to our Texas provider resources can be found on the left or below.
Ambetter Providers Click For More Information (Health Insurance Marketplace)
Texas Medicaid Provider Resources
- Allwell Qualified Medicare Beneficiaries FAQ (PDF)
- Balance Billing: Superior Medicaid and CHIP (PDF)
- Balance Billing: Allwell from Superior HealthPlan and STAR+PLUS MMP (PDF)
- TurningPoint – Procedure Coding and Medical Policy Information (PDF)
- Ontrak Program Service Claims - Frequently Asked Questions (PDF)
- EVV FAQ (PDF)
- EVV Provider Compliance Plan (PDF)
- EVV Provider Training (PDF)
- HHS EVV Aggregator and EVV Portal Webinar (PDF)
- HHS EVV Contact Information Matrix (PDF)
- HHS EVV Policy Handbook
- HHS EVV Provider Stakeholder Presentation (PDF)
- HHS EVV Reason Code FAQ (PDF)
- HHS EVV Reason Code Scenarios (PDF)
- HHS EVV Responsibilities and Additional Information, 1718 Form (PDF)
- HHS EVV Service Bill Codes Table (PDF)
- HHS EVV Temporary EVV Policies for Severe Winter Weather (PDF)
- HHS EVV Temporary Policies for COVID-19 (PDF)
- HHS EVV Vendor Selection for Cures Act EVV Expansion (PDF)
- HHS EVV Tool Kit - EVV Visit Maintenance and Transactions (PDF)
- HHS EVV Tool Kit Module 1 - Introduction to EVV (PDF)
- HHS EVV Tool Kit Module 2 - EVV Roles and Responsibilities (Part 1) (PDF)
- HHS EVV Tool Kit Module 3 - EVV Roles and Responsibilities (Part 2) (PDF)
- HHS EVV Tool Kit Module 4 - EVV Visit Transactions (PDF)
- HHS EVV Tool Kit Module 5 - EVV Visit Maintenance (PDF)
- HHS EVV Tool Kit Module 6 - EVV Process Flow (PDF)
- HHS EVV Tool Kit Module 7 - EVV Aggregator and Portal (PDF)
- HHS EVV Tool Kit Module 8 - Submitting an EVV Claim (PDF)
- HHS EVV Tool Kit Module 9 - EVV Portal Standard Reports and Search Tools (PDF)
- HHS EVV Tool Kit Module 10 - EVV Visit Transaction Validation Enhancements (PDF)
- HHS EVV Tool Kit Module 11 - Summary of EVV Changes (Part 1) (PDF)
- HHS EVV Tool Kit Module 12 - Getting Started - Next Steps (PDF)
- HHS EVV Tool Kit Module 13 - EVV Training Requirements (PDF)
- HHS EVV Tool Kit Module 14 - EVV Compliance Oversight Policies (PDF)
- HHS EVV Tool Kit Module 15 - Best Practices to Avoid EVV Claim Mismatches (PDF)
- Requests for Program Provider and FMSA (Excel)
- Request for Consumer Directed Services Employers (Excel)
- 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 manage the prior authorizations for non-emergent, outpatient imaging and pain management services rendered to Superior HealthPlan members.)
- NIA: High Tech Imaging QRG for Rendering Facilities (PDF)
- NIA: High Tech Imaging QRG for Ordering Physicians (PDF)
- NIA: Interventional Pain Management Quick Reference Guide (QRG) (PDF)
- NIA: Interventional Pain Management Frequently Asked Questions (FAQ) (PDF)
- NIA: Physical Medicine (Therapy) Quick Reference Guide (QRG)
- NIA: Physical Medicine (Therapy) Frequently Asked Questions (FAQ)
To review additional NIA resources, please visit the NIA Superior HealthPlan webpage.
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.
- 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)
- Prior Authorization List - CHIP (PDF)
- Prior Authorization List - Medicaid (PDF)
- Skilled Nursing Requirements Checklist (PDF)
- Vehicle Modification Request Packet - STAR+PLUS (PDF)
- Vehicle Modification Request Packet - STAR+PLUS Medicare-Medicaid Plan (MMP) (PDF)
Quality Improvement resources have moved. Please visit Superior's QI Program.
- Acute Care and Hospitals 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)
- Ophthalmology Quick Reference Guide (PDF)
- PCP 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)
- Wellcare By Allwell Quick Reference Guide (PDF)
- Early Childhood Intervention - Individualized Family Service Plan Information (PDF)
- 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)
- Therapy Prior Authorization Requests: Clinical Documentation Criteria Quick Reference Guide (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.
- Ambetter Provider Toolkit can be found on Ambetter's Provider Resources webpage.
- Medicaid Provider Toolkit (PDF)
- Wellcare By Allwell Toolkit (PDF)
- 3 in 30 Provider Resources
- Guidelines on After Hours Telephone Accessibility (PDF)
- National Kidney Foundation - Chronic Kidney Disease (CKD) Risk Assessment Tool (PDF)
- HHS Early Childhood Intervention Services
- HHS 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)