Ambetter from Superior HealthPlan
• Ambetter from Superior HealthPlan is an HMO Benefit Plan. • Members enrolled in Ambetter must use in- network participating providers, except in the case of emergency services. • If an out-of-network provider is used (except in the case of emergency services), the member will be 100% responsible for all charges.
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Ambetter from Superior HealthPlan
www.superiorhealthplan.com• High-Tech Imaging (i.e., CT, MRI, PET) • Infertility • Obstetrical Ultrasound – Two allowed in a nine month period. Any additional ultrasounds will require prior authorization (unless rendered by a Perinatologist). – For urgent/emergent ultrasounds, treat using best clinical judgment and authorizations will be reviewed retrospectively.
Form, Superior, Imaging, Ultrasound, Healthplan, Ambetter, Obstetrical, Obstetrical ultrasound, Ambetter from superior healthplan
REQUEST FOR PRIOR AUTHORIZATION - Superior HealthPlan
www.superiorhealthplan.comAuthorization Number. Units Dates Authorized. Genetic Testing Type: Pregnant. Yes No. Urgent Request - By checking this box, I certify that this is an urgent request medically necessary treatment, which must be treated within 24 hours.
Superior HealthPlan PHONE: o Physical Health: 1-800-218 ...
www.superiorhealthplan.comPhysical Therapy, Occupational Therapy, Speech Therapy Skilled Nursing Visits Private Duty Nursing Abdominal Hysterectomy Bariatric Surgery Circumcision (One year and older) Cardiac Surgeries ENT Services: Nasal/Sinus Endoscopy, Tonsillectomy & Adenoidectomy, Typanostomy, Myringotomy Musculoskeletal Surgical Procedures
CLAIMS APPEAL PAYMENT RECONSIDERATION & DISPUTE …
www.superiorhealthplan.comPlease complete the following form to help expedite the review of your claims appeal. *Is this a. Request for Reconsideration: you disagree with the original claim outcome (payment amount, denial reason, etc.) Please check if this is the first time you are asking for a review of the claim. ... Farmington, Missouri 63640- 3800 . Author: Jill ...
Tamiflu® Treatment and Prophylaxis Information per CDC ...
www.superiorhealthplan.como Prevention of influenza among residents of institutions, such as long-term care facilities, during influenza outbreaks in the institution. For more information, see IDSA Guidelines website. An emphasis on close monitoring and early initiation of antiviral treatment if fever and/or respiratory symptoms develop is an alternative to
Medicare Prior Authorization List Effective January 1, 2021
www.superiorhealthplan.comBreast Reduction Capsule Endoscopy Chondrocyte Implants Cochlear Implant Facial Osteotomy Hysterectomy Joint Replacements Mastectomy for Gynecomastia . Medicare Prior Authorization List . Effective January 1, 2021 . ... J7326 GEL-ONE J7327 MONOVISC INJ PER DOSE J7328 HYAL/DERIV GELSYN-3 IA INJ 0.1 MG ...
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Claim Adjustment Reason Codes Crosswalk to EX Codes
www.superiorhealthplan.comClaim Adjustment Reason Codes Crosswalk to EX Codes: SHP_20161447 2 Revised April 2016 EX Code Reason Code (CARC) RARC DESCRIPTION TYPE EXCB 15 N596 AUTHORIZATION IS CANCELLED -ERROR IN ENTRY DENY EXHc 15 . N517 DENY: NO AUTHORIZATION ON FILE THAT MATCHES SERVICE(S) BILLED . DENY EXhf . 15 N596 . DENY: NO …
Claim Adjustment Reason Codes Crosswalk
www.superiorhealthplan.comex07 7 n517 deny: the procedure code is inconsistent with the patient s sex deny ex09 9 n657 deny: the diagnosis is inconsistent with the patient s age or sex deny ... visit & preven codes are not payable on same dos w o documentation deny ... svc not covered based on age of patient and provider specialty deny
Code, Specialty, Claim, Reasons, Adjustment, Crosswalk, Claim adjustment reason codes crosswalk
Wellcare By Allwell
www.superiorhealthplan.comHEDIS/Care gap reviews Financial analysis EHR Utilization Demographic information updates Initiate credentialing of a new practitioner . Confidential and Proprietary Information Membership. Confidential and Proprietary Information ... Supplemental Benefits at a Glance
TX-PAF-5869 - Medicaid Prior Authorization Fax Form
www.superiorhealthplan.comMEDICAID PRIOR AUTHORIZATION FORM Complete and Fax to: 800-690-7030 Behavioral Health Requests/Medical Records: Fax. 866-570-7517. Transplant: Fax. 833-589-1245 . Request for additional units. Existing Authorization. Units. Urgent requests - I certify this request is urgent and medically necessary to treat an injury, illness or condition (not ...
Medicaid, Authorization, Prior, Medicaid prior authorization
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Texas - Superior HealthPlan
ambetter.superiorhealthplan.comAmbetter from Superior Healthplan Attn: Level I - Request for Reconsideration PO Box 5010 Farmington, MO 63640 -5010 Ambetter from Superior Healthplan Attn: Level II – Claim Dispute PO Box 5000 Farmington, MO 63640 -5000
Medicare Advantage HHSC Contract Number CMS Code Plan …
www.tmhp.comSuperior HealthPlan, Inc. HHS000521900001 H5294 007 Allwell Dual Medicare (HMO SNP) SNP Fort Bend, Montgomery. Medicare Advantage Plan MCO HHSC Contract Number CMS Code Plan ID Plan Name Type Counties Served Superior HealthPlan, Inc. HHS000521900001 H5294 009 Allwell Dual Medicare (HMO SNP) SNP Lubbock
2021 Prescription Drug List - Superior HealthPlan
ambetter.superiorhealthplan.com2021 Prescription Drug List Effective January 1, 2021. Ambetter.SuperiorHealthPlan.com
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Ambetter from Superior HealthPlan
www.superiorhealthplan.comsuperior Health Insurance FROM healthplan~ Marketplace PCP Selection and Panel Status: • Ambetter emphasizes to members the importance of establishing a medical home (better care, greater appointment availability, consistent care, etc.). Part of that is the selection of a Primary Care Provider (PCP).
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Secure Provider Portal - Superior HealthPlan
staging3.centene.comSuperior’s Secure Provider Portal makes managing patient administrative tasks easy and convenient. Using our online tool, you can get immediate access to patient information to check eligibility for Superior member appointments, view care gaps as well as manage claims and other administrative tasks with ease.
Assurance™ EDI - Claim Status Payer List
connectcenter.changehealthcare.comAllwell from Superior HealthPlan CNTENE 7785/8527 No 68069 Real Time No Allwell from Western Sky Community Care CNTENE 1075/8102 No 68069 Real Time No Altius ALTIUS 1837/8538 No SX113 Real Time No Ambetter from Health Net CNTENE 7808/8583 No 68069 Real Time No Ambetter from Homestate Health CNTENE 7809/8584 No 68069 Real Time No ...
Summary of Benefits and Coverage: What this Plan Covers ...
api.centene.comAmbetter from Superior HealthPlan: Coverage for: Individual/Family | Plan Type: EPO Ambetter Balanced Care 32. SBC-29418TX0140101-06 Underwritten by Celtic Insurance Company . The Summary of Benefits and Coverage (SBC) document will help you choose a health plan.
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Payer Claims List - edsedi.com
edsedi.com61425 ACEC-Healthplan No 61474 ACS Benefit Service (PO Box 2400 Winston, NC only) No 72468 ACS Benefit Services (Salem Winston, NC) No ... CPPSA Advantage by Superior (PO Box 537030, Sacramento, CA No 83077 Advantek Benefit Admin (Fresno, CA) No 43168 Advantica Administrative Svcs (St. Louis, MO) No
Lists, Claim, Superior, Payer, Healthplan, Payer claims list
ECHO Electronic Remittance Advice ERA 835 - eSolutions
payerlist.claimremedi.comAmerica’s Choice Healthplan Gateway Health Plan - Medicare AmeriHealth Caritas Delaware GemCare – Manag ed Care Systems AmeriHealth Caritas District o f Columbia Global Care – Boulder Adm inistration AmeriHealth C aritas Louisiana G.M.P. – Employers Retiree Trust AmeriHe alth Caritas Pennsylvania GMS, Inc.