Symptoms may appear 2-14 days after exposure.

Simply call Superior Member Services. Superior HealthPlan is committed to providing our participating providers with the best tools possible to support their administrative needs. Verbal complaints will be accepted via our toll-free number (below) or face-to-face. Providers may appeal claim recoupment by submitting the following information to HHS: Members may file complaints to Superior verbally or in writing, at any time. Download the free version of Adobe Reader. Jewelry Insurance. We will follow these CMS published rates except where state-specific Medicaid rate guidance should supersede. The following guidance can be used to bill for services related to COVID-19 testing, screening and treatment services. Superior’s Member Services Departments can be reached at: Members can also file a written complaint online through Superior’s website by clicking here. New Markets "Need more Training" Sign Up.

our carriers.

Superior Dental Care The Dental Benefit Innovators™ 6683 Centerville Business Parkway Centerville, OH 45459 Local: 937-438-0283 Toll-Free: 800-762-3159 Superior recognizes that there are times when a provider may not be satisfied with a matter handled by Superior. Please select Member in the dropdown menu to log in to or create your secure online member account. Texas Health and Human Services

for our online Webinar! Login User Name Password Forgot Password. In instances where the member’s request for an expedited appeal is denied, the appeal must be transferred to the timeframe for standard resolution of appeals. CHIP members are required to file complaints in writing. Superior HealthPlan and Centene Guidance and resources for Superior HealthPlan providers. Medical necessity appeals are submitted to Superior to: Superior HealthPlan You will need Adobe Reader to open PDFs on this site. You will need Adobe Reader to open PDFs on this site. We will temporarily waive requirements that out-of-state Medicare and Medicaid providers be licensed in the state where they are providing services when they are licensed in another state.

You can also request any materials on this website in another format, such as large print, braille, CD or in another language. Box 85200 Mailing or faxing a written complaint to the following: The reduction, suspension, or termination of a previously authorized service; The denial, in whole or part, of payment for a service excluding technical reasons; The failure to render a decision within the required timeframes; or. The failure to respect the Medicaid member’s rights. Find everything you need in the member online account. Patients with COVID-19 have reported mild to severe respiratory symptoms. P.O. If you need help understanding the language being spoken, Superior has people who can help you on the phone or can go with you to a medical appointment. Some content on this website is saved in PDF format.

No punitive action will be taken against a provider that requests an expedited resolution or supports a member’s appeal.

Superior shall make reasonable efforts to provide the member with prompt verbal notice of any decisions that are not resolved wholly in favor of the member and shall follow-up within two  calendar days with a written notice of action. P.O.

You will receive notice when necessary. Have you sold your first jewelry insurance policy yet? Austin, Texas 78714-9091. Know the warning signs of COVID-19. If a Medicaid member is not satisfied with the outcome of the appeal, they can file a complaint with the Health and Human Services (HHS) at 1-866-566-8989 or by mail at the address below. Please review all available provider guidance, actions and resources listed below. CHIP members also have the right to complain to the Texas Department of Insurance (TDI) by calling toll free 1-800-252-3439 or contacting them in writing at: An appeal is the request for review of a “Notice of Adverse Action.”  A “Notice of Adverse Action” is considered the denial or limited authorization of a requested service, including: The review may be requested orally or in writing; however, oral requests for appeals within the standard timeframe must be resolved within thirty (30) days of receipt of the appeal, with a 14-day extension possible if additional information is required. The response to the complaint will be provided in writing in the form of a resolution letter. The nurses can respond to calls from providers and members seeking clinical information, guidance on specialty referrals or requests for specialty provider consultations. Providers have the right to file a complaint related to that matter. 04/17/17. Medicaid members can file a complaint through the Office of Long Term Care Ombudsman online, by calling toll free at 1-800-252-2412. Simply call Superior Member Services. Consumer Protection Mail Code 111-1A Other symptoms include fatigue, sputum production, and muscle aches. Contact Provider Services for information or questions on benefits, claims, authorizations and billing inquiries. Ambetter from Superior HealthPlan Please note: For all codes that require manual pricing, Superior HealthPlan will pay at 38% of billed charges. Medicaid providers may file a complaint with HHS after exhausting Superior’s complaint procedures by submitting to HPM_Complaints@hhsc.state.tx.us and for STAR Health STAR.Health@hhsc.state.tx.us or: Texas Health and Human Services When a complaint is received, a written acknowledgment is sent to the member within five (5) business days. Download the free version of Adobe Reader. A written complaint can also be mailed or faxed to: Superior HealthPlan 5900 E. Ben White Blvd. 1-877-687-1196, CHIP, CHIP RSA, STAR, STAR+PLUS, STAR+PLUS MMP, STAR Kids and Medicare Advantage You will need Adobe Reader to open PDFs on this site. Review your infection prevention and control policies and. 99001 can be reimbursed for the following place of service and provider type: We are complying with the rates published by CMS for the following codes. There are a variety of ways in which a member complaint can be filed. You will need Adobe Reader to open PDFs on this site. For more information on how to file a complaint, please review How to Submit a Complaint as a Medicaid Provider. Any additional rates will be determined by further CMS and/or state-specific guidance and communicated when available.

For screening or treatment not related to COVID-19 normal copayment, coinsurance, and deductibles will apply, where applicable. Our secure portal allows you to submit your claims quickly and easily online as well as request copies of your Explanation of Payment (EOP). We have been working with Superior Access for 3 years. §438.400, possible subjects for complaints include, but are not limited to: Superior offers a number of ways to file a written complaint, as listed below: For help filing a provider complaint or to check on the status of a provider complaint, providers may email TexasProviderComplaints@centene.com. For member information, please reference the Coronavirus Updates for Members webpage. The hotline is staffed with nurses who are knowledgeable about Medicaid and CHIP benefits and services. Date:

If you need help understanding the language being spoken, Superior has people who can help you on the phone or can go with you to a medical appointment. *In addition to updating information with Superior, providers must also update their demographics with Texas Medicaid & Healthcare Partnership (TMHP). Explore alternatives to face-to-face triage and visits as possible, and manage mildly ill COVID-19 cases at home, if possible.

Reimbursement rates are still pending from CMS and this communication will be updated when available. The Formulary, pharmacy network, and provider network may change at any time. However, be aware that infected individuals can be contagious before symptoms arise. Coronavirus disease 2019 (COVID-19) is an emerging illness. © Copyright 2020 Celtic Insurance Company.

Superior recognizes that there are times when a provider may not be satisfied with a matter handled by Superior.



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