Superior HealthPlan. Assisted Living, Residential Care and Adult Foster Care SHP_

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Superior HealthPlan

Assisted Living,

Residential Care and

Adult Foster Care

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Who is Superior HealthPlan?

 _{Superior HealthPlan is a subsidiary of Centene Management Corporation, a Fortune} 500 Company, located in St. Louis, Missouri. Centene’s managed care model utilizes integrated programs that can only be delivered effectively by a local staff combined with centralized finance, information systems, and claims processing

 _{Superior HealthPlan Inc., is a licensed HMO in all 254 counties of the State of Texas}  Superior HealthPlan offers different products to help ensure eligible Texans across the

income, age and acuity continuum  _{Our Products}:

 Contracted through Texas HHSC to provide: STAR+PLUS, STAR, CHIP, STAR Health (Foster Care)

 Contracted through Federal Government to provide: Advantage by Superior

HealthPlan dual Special Needs Plan (SNP) HMO (Medicare Advantage Plan), and Ambetter (Health Insurance Marketplace)

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How is Eligibility Verified?

• Texas Medicaid Benefits Card

• TexMedConnect – http://www.tmhp.com/Pages/EDI/EDI_TexMedConnect.aspx • Superior HealthPlan Identification Card

• Superior HealthPlan Secure Web Portal - www.SuperiorHealthPlan.com • Superior HealthPlan STAR+PLUS Member Services: 1-866-516-4501

• Verify eligibility the 1st of each month using our website or by contacting

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Member ID Cards

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Service Coordination

 Single Point of Contact for the member

 Review Assessments and develop plan of care utilizing input from member, family and providers

 Coordinate with the member’s PCP, specialist and LTSS providers to ensure the member’s health and safety needs are met in the least

restrictive setting

 Refer member to support services such as disease management and community resources

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Service Coordination

 Authorize LTSS services

 Service Coordination utilizes a multidisciplinary approach in meeting members needs including behavioral health

 Conduct mandatory telephonic or face to face contacts

 Service Coordinator member caseloads are assigned by mixed model that includes member’s level of acuity, zip codes, DAHS facility

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Locating Member’s Service Coordinator

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Effective 9/1/2014 Members and Providers will be able to

access the name and phone number of the assigned Service

Coordinator via the secured member and provider web portal

 Members will find their assigned Service Coordinator and phone number on their front page under Health Alerts

 When providers access eligibility on a specific member, the assigned Service Coordinator and phone number is displayed on the Eligibility Overview page under Care Gaps

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Authorization Specifics

 Services are initiated as the need is identified by the following avenues:

 _{The Member’s Service Coordinator}

 The Provider, PCP, Hospital or Nursing home discharge planner  _{Medical Necessity Level of Care Assessment (waiver specific)}

 To initiate pre-authorization requests or any changes to an authorization, providers may call the Service Coordination department or fax a 2067 Form

 _{Superior HealthPlan sends summary reports to providers each month listing all} members in the facility to assist with reconciliation and ensure accuracy of

authorizations

 _{Any applicable copay is determined by the STAR+PLUS Support Unit and}

provided to Superior HealthPlan. The provider is responsible to collect room & board and copays from the member or their representative

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All authorizations for LTSS services are obtained through

the Service Coordination Department

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A member’s specific Service Coordinator’s name can be

seen when a member’s eligibility is confirmed through the

Superior HealthPlan secure portal

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Then call 1-877-277-9772 to speak to a Service

Coordinator

How do I get authorizations for

LTSS services?

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Billing Requirements

All claims must be billed with appropriate modifiers. The authorization will also include procedure codes and modifiers. Do not deduct Room & Board or applicable copay from claims. Copay is deducted from the claim upon adjudication.

Place of Service Codes-

13 - Assisted Living /Residential Care 12 - Adult Foster Care

Procedure codes-

Assisted Living/ Residential Care - T2031 Adult Foster Care - S5140

Taxonomy Code-

Assisted Living / Residential Care- 310400000X Adult Foster Care - 311ZA0620X

Units = 1 Day

* If provider bills less than contracted

amount, the claim will be eligible for

reimbursement at the lesser of billed

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Provider Portal

http://www.Superiorhealthplan.com/

• SUBMIT CLAIMS ON-LINE! • Check claim status

• Verify eligibility

• View Provider Directory • View Provider Manual

• Submit Online Authorizations (acute care only) • Request copy EOP

• Link for Providers to file On-Line complaints • Provider Group Training Schedule

• Provider On-Line Training Schedule • Links for additional Provider Resources