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Durable Medical Equipment (DME)

All Durable Medical Equipment (DME) and supply providers must be Medicare-certified before applying for enrollment in Texas Medicaid. All newly enrolling and re-enrolling DME providers must, as a condition of enrollment and continued participation into Texas Medicaid, obtain a surety bond that complies with Title 1, Texas Administrative Code (TAC) §352.15. The surety bond is then submitted to TexasMedicaid by the provider and must be renewed annually.

For more information on how to become an in-network provider with Superior HealthPlan, please visit Superior’s Network Request or Update webpage.

For information or questions on benefits, claims, authorizations, and billing inquiries, please contact Provider Services. To expedite your call, have the following information ready:

  • Tax Identification Number (TIN)
  • National Provider Identification Number (NPI)
  • Member ID Number
  • Member Date of Birth
  • Billed amount of claim
  • Date of service

Superior Service Coordinators provide a specialized level of care coordination that includes, but not limited to, coordinating with the STAR+PLUS, STAR Kids, STAR Health and MMP member’s PCP, specialists, and Long-Term Services and Supports (LTSS) providers. This ensures the member’s health and safety are met in the least restrictive setting.

 Providers can contact Superior’s Service Coordination team by phone.

Superior has adopted a prior authorization process for specific procedures and/or services. Failure to obtain prior authorization for services that require prior authorization will result in an administrative denial. Please note, if any prior authorization form is returned with the language PA Not Required, the requesting provider should verify if the service is a covered benefit and requires authorization.

 For Prior Authorization Request forms, please visit Superior’s Provider Forms webpage.

 If you need assistance completing a request for services or need more information, please contact Superior’s Utilization Management department using the phone numbers listed below:

DME providers and agencies are encouraged to fill out the following form to help highlight DME supplies available to Superior members through your organization: Durable Medical Equipment (DME) Provider Database.

Providers can find the following DME policies in the Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS) and CHIP Policies section of Superior's Clinical, Payment & Pharmacy Policies: 

Medicaid and CHIP Clinical (Medical)

  • Durable Medical Equipment (DME) (CP.MP.107) (PDF)
  • Custom Mobility Seating and Systems (TX.CP.MP.599) (PDF)
  • Diabetic Supplies (TX.CP.MP.526) (PDF)
  • Durable Medical Equipment and Medical Supplies
    (TX.CP.MP.552) (PDF)
  • Enteral Nutrition (TX.CP.MP.550) (PDF)
  • Oxygen Use and Concentrators (CP.MP.190) - for CHIP
    only (PDF)
  • Phototherapy for Neonatal Hyperbilirubinemia (CP.MP.150)
    (PDF)

Medicaid and CHIP Payment

  • Unlisted Procedure Codes (CC.PP.009) (PDF)
  • Wheelchair and Accessories (CC.PP.502) (PDF)

For a full list of trainings available to providers, please visit Superior's
Training and Manuals webpage.

Access Provider Toolkits by visiting Superior’s Provider Toolkits.