Billing and Coding

Superior HealthPlan strives to give our participating providers the best tools possible to support their administrative needs.  Our electronic transactions capabilities will speed up the processing and payment of your claims.

Providers may elect to submit electronic professional or institutional claims through Superior’s Provider Portal at Provider.SuperiorHealthPlan.com or using a clearinghouse for electronic claim submissions.

Providers may also submit claims on paper, utilizing the standardized CMS-1500 and/or UB-04/CMS-1450 claim forms.

Please note: Out-of-Network providers, must bill one claim electronically, using EDI or by paper first to be set up in Superior’s Secure Provider Portal. To send a claim by paper, please mail claim forms to: Superior HealthPlan, Attn: Claims, P.O. Box 3003, Farmington, MO 63640-3803.

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:  www.payspanhealth.com

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.

The following list contains contact information for the trading partners currently active with our health plan. All providers are encouraged to contact one of these trading partners to utilize our electronic transaction options.

Superior HealthPlan Product

Medical Claims

Behavioral Claims

Ambetter from Superior HealthPlan

68069

68069

CHIP

68069

68068

STAR

68069

68068

STAR HEALTH

68069

68068

STAR Kids

68069

68068

STAR+PLUS

68069

68068

STAR+PLUS MMP

68069

68069

Superior HealthPlan Medicare Advantage (HMO SNP)

68069

68069

*68068 is the Payer ID for Cenpatico Behavioral Health which is contracted by Superior to authorize and manage Behavioral Health Services for our members in most locations. For certain product lines, Cenpatico is also responsible for claims payment.

Effective November 1, 2017, management of behavioral health functions will transition from Cenpatico (a subsidiary of Envolve PeopleCare) to Superior HealthPlan. The new Payer ID for behavioral health providers will change to 68069 begining November 1, 2017.

Trading Partners

Telephone 

Allscripts/Payerpath

1-888-684-7466

Availity

1-877-334-8446

Capario

1-800-792-5256

Claim Remedi

1-800-763-8484

Claimsource

1-262-544-4442

CPSI

1-251-639-8200

DeKalb

Pending Verification

Emdeon

1-800-845-6592 #2

First Health Care

1-216-236-2020

Trizetto Provider Solutions, LLC.

1-800-969-3666

GHNonline

Pending Verification

IGI/HealthEC

1-800-444-0278

MD On-Line

1-888-499-5465

Physicians CC

1-802-846-8177

Practice Insight

1-713-333-6000

Relay/ Mckesson

1-800-527-8133 #1

Smarta Data

1-855-650-6590

SSI

1-800-772-1213

Viatrack

1-800-426-3385

Direct Submission Instructions

Direct Submission Testing

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 https://www.cms.gov/Regulations-and-Guidance/HIPAA-Administrative-Simplification/Versions5010andD0/Version_5010.html 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

Where can providers/groups locate a listing of the clearinghouses and software vendors that have been approved to exchange 5010 transactions with Superior?

The current list of clearinghouses and software vendors approved to exchange 4010 transactions with Superior will be updated as successful 5010 testing is completed on each Centene plan website.

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 page, 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 at https://www.wpc-edi.com.

Trading partners may access the 4010 v 5010 comparison documents created by the Centers for Medicare & Medicaid Services (CMS) at https://www.cms.gov/ElectronicBillingEDITrans/18_5010D0.asp.

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 Account Manager 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.