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 Here (Health Insurance Marketplace)
Billing Resources
- Filing Deadline Calendar for 2018 (PDF)
- Filing Deadline Calendar for 2017 (PDF)
- Filing Deadline Calendar for 2016 (PDF)
- Standardized Durable Medical Equipment (DME) Listing (PDF)
- Texas Medicaid Claims Filing Procedures
Electronic Visit Verification (EVV)
- EVV FAQ (PDF)
- EVV Provider Compliance Plan (PDF)
- EVV Provider Training (PDF)
- HHSC EVV Provider Stakeholder Presentation (PDF)
- HHSC EVV Reason Code FAQ (PDF)
- HHSC EVV Reason Code Scenarios (PDF)
- For the most recent EVV updates, please visit EVV News and Announcements
High Tech Imaging
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
Nurse Advice Line
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
- 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)
Private Duty Nursing
- Addendum to Billing Methodology for PDN Multiple Ratio with Hospital Admission Event (PDF)
- Fee and Billing (PDF)
- Medical Criteria, Parameters for Medically Necessary Hours, and Exceptions Process (PDF)
- Private Duty Nursing Requirements Checklist (PDF)
Process Improvement Resources
- Secure Provider Portal
- Find my Provider Account Manager
- Expedited Credentialing (PDF)
- Member Rights and Responsibilities
Quality
- Quality Improvement resources have moved, please visit Superior's QI Program.
Quick Reference Guides & Contacts
- Acute Care and Hospitals Quick Reference Guide (PDF)
- FQHC Payment Process Quick Reference Guide (PDF)
- FQHC Frequently Asked Questions (PDF)
- HEDIS Guidelines for Monitoring for Patients on Persistent Medications (PDF)
- Medicare Advantage Quick Reference Guide (PDF)
- PCP Quick Reference Guide (PDF)
- Texas Health Steps Quick Reference 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)
Therapy Documents & Policy Clarification
- At-Home Therapy Attestation Statement (PDF)
- Clinical Practice Standards for Therapy Documentation (PDF)
- Early Childhood Intervention (PDF)
- Initial Evaluation Request for Therapy - Supplemental Information (PDF)
- Requirements For Therapy Authorization Checklist (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 Guidelines (PDF)
Texas Health Steps
- 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)
Texas Medicaid Re-enrollment
For the most updated information or to re-enroll, please visit TMHP.com.
Toolkits
Additional Resources
- 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)
- Prenatal Screening for Domestic Violence and Substance Use
- Signing up for EFT through PaySpan (PDF)
- Texas Health and Human Services Provider Fraud Notice (PDF)