Billing and Coding

Superior HealthPlan is pleased to partner with PaySpan Health to provide an innovative web based solution for Electronic Funds Transfers (EFTs) and Electronic Remittance Advices (ERAs).  This service is provided at no cost to providers and allows online enrollment.

Benefits include:

• Elimination of paper checks - all deposits transmitted via EFT to the designated bank account
• Convenient Payments & Retrieval of remittance information
• Electronic remittance advices presented online
• HIPAA 835 electronic remittance files for download directly to a HIPAA-Compliant Practice Management for Patient Accounting System
• Reduce accounting expenses – Electronic remittance advices can be imported directly into practice management or patient accounting systems, eliminating the need for manual re-keying
• Improve cash flow – Electronic payments can mean faster payments, leading to improvements in cash flow
• Maintain control over bank accounts - You keep TOTAL control over the destination of claim payment funds.  Multiple practices and accounts are supported
• Match payments to advices quickly – You can associate electronic payments with electronic remittance advices quickly and easily
• Manage multiple Payers – Reuse enrollment information to connect with multiple Payers Assign different Payers to different bank accounts, as desired

Visit PaySpan’s website for more information.

Electronic Transactions (EDI) support for HIPAA transactions is provided for the health plan by Centene Corporation. Centene is currently receiving professional, institutional and encounter transactions electronically, as well as generating an electronic remittance advice/explanation of payment (ERA/EOP). To conduct other HIPAA transactions not listed, please contact our EDI department at 1-800-225-2573, ext. 6075525.

*68068 is the Payer ID for Behavioral Health Services for our members in most locations. 

While Superior can only accept direct EDI submissions from the trading partner below, providers may continue to the trading partner they are contracted with and these submissions will be routed through our designated direct submitter provider.

Direct Submission Instructions (PDF)

Direct Submission Testing Portal

Correct Use of the Date of Service/Onset Date Fields

If the onset date is the same as the date of service, leave the onset date field blank.  Entering the same date on both the onset field and service field will cause an error.

If the onset date is prior to the date of service, enter the two dates in their applicable fields.

National Provider Identifier (NPI) vs Social Security Number (SSN)

Be sure to use the NPI and not an employer identification or social security number as the primary identifier on your claim. 

Please visit the Centers for Medicare & Medicaid Services website or for more information on data reporting changes in the Version 5010 transactions.

Does Superior HealthPlan support the version 5010 TR3 Errata?

Superior supports HIPAA adopted TR3 Errata, when applicable and most up to date version.

• 835 Health Care Payment/Advice 005010X221A1
• 837 Health Care Claim: Professional 005010X222A1
• 837 Health Care Claim: Institutional 005010X223A2
• 276/277 Status Inquiry and Response 005010X212
• 999 Implementation Acknowledgment 005010X231A1
• 997 Acknowledgement of file received upon request

What is a 5010 Companion Guide?

A 5010 Companion Guide is a supplemental document that clarifies the situational rules stipulated in the 5010 TR3 manuals. Transaction-specific, these companion guides further define what is required to process transactions efficiently through Superior.

Which 5010 companion documents will Superior provide?

Superior will provide a transaction-specific companion guide for all 5010 health-care transactions.

Where are the 5010 Companion Guides?

The guides are found on Superior's Provider Forms webpage, under Medicare Claims Forms and EDI Tools. One guide will be used for all Centene plans.

What type of acknowledgement reports are used for 5010?

In production, Superior will use the TA1 Interchange Acknowledgement, 997 Implementation Acknowledgement if requested and the Superior audit report. In test, Superior will use a response report (audit report) indicating accept/reject status. This answer also applies to the secure provider portal.

Will trading partners receive error-readable reports for 5010?

Superior will continue to provide Superior audit reports indicating accept and reject status.

Will Submitter IDs change with 5010?

No. Trading partners will not need new submitter IDs for 5010 transactions.

Are there other references available for trading partners to prepare for 5010?

It is the responsibility of trading partners to purchase their own TR3 guides the through Washington Publishing Company website.

Trading partners may access the 4010 v 5010 comparison documents created by the Centers for Medicare & Medicaid Services (CMS) on the CMS Electronic Billing & EDI Transactions webpage.

Will providers need to change their National Provider Identifier (NPI) for 5010?

Appropriate NPI enumeration is the responsibility of the provider. Please review the front matter of the 837 TR3, section 1.10 to determine if a new NPI is needed.

Who should providers contact regarding specific claims billing questions?

Providers should continue to contact their Provider Representative at their plan regarding billing.

Providers should continue to contact the EDI Service Desk for EDI rejects and questions regarding EDI transactions. The EDI Service Desk can be reached at EDIBA@CENTENE.COM or 1-800-225-2573 ext. 6075525.