Click Here. For technical support, call the CareFirst Help Desk at (877) 526 8390. To access the phone numbers for inpatient notification and prior authorization for each applicable service type, please refer to the. Find a SCAN Sales Representative in your neighborhood. Service Coordinators are available to help you coordinate your/your childs medical and behavioral health care. G0297. Questions may also be sent via secure message through the provider and member portals. You cannot request an External Medical Review without also requesting a State Fair Hearing. CST Tuesday-Friday Second weekend of the month: Saturday and Sunday 8:00 a.m. - 5:00 p.m. CST As the year ended, the United States surpassed 20 million infections from SARS-CoV-2, and more than 346,000 deaths. Request Network Participation, Non-Contracted Providers Only, Add a Provider to an Existing Group Contract, Add a Practice Location to an Existing Contract, Practice Improvement Resource Center (PIRC), Updating Provider Demographic Information, Effective 1/1: Electronic Prescribing of Controlled Substances Required, Effective September 1, 2021: Benefit Changes to Total Disc Arthroplasty for Medicaid and CHIP, Effective July 15, 2021 through December 31, 2021: Temporary Relaxation of Prior Authorization Requirements for DME, Orthotic, and Enteral/Parenteral Nutrition and Medical Supplies, Javelina legend and NFL hall of famer Darrell Green gives back to Kingsville, Superior HealthPlan, Pro Football Hall of Famer Darrell Green Help Make First Back-to-School Community Fair & Fest in Kingsville a Success, Provider Notice of Adverse Benefit Determinations, Superior to Override Timely Filing for Claims Impacted by Texas Medicaid Healthcare Partnerships (TMHP) Eligibility Verification Issues, Fill out the State Fair Hearing and External Medical Review Request Form provided as an attachment to the Member Notice of Superior's Internal Appeal Decision letter and mail or fax it to Superior by using the address or fax number at the top of the form; or. They can visit you at home, talk to you on the phone or send you facts by mail. Click here to read the full disclaimer. 711 for Telecommunications Relay Services/TRS. Out-Patient RX (Envolve Pharmacy Solutions) Resolution Help Desk: 1 The determination should be completed within three (3) business days of the referral to the Medical Director. Member login. Superior wants to make sure members get the care and support they need. Utilization review decisions are made in accordance with generally-accepted clinical practices, taking into account the special circumstances of each case that may require an exception to the standard. However, information provided by the providers office will also satisfy this requirement. Provider Information & Resources Prior Authorization Guidelines and Forms Provider We can also have an interpreter meet you at your doctors office if you provide at least 48-hours notice. All essential information must be included on each PA request. Anonymous reporting is accepted. Those requests will be reviewed to determine the medical necessity of approving the delivery of care outside of Superiors contracted provider network, for those situations in which no contracted provider is available to deliver the applicable service. HEALTH first 1-888-672-2277 KIDS first 1-888-814-2352 Call Monday through Friday 8 am to 5 pm CST Provider Resources Prior Authorization Requests Claims Information Texas Health and Human Services Commission (HHSC) Texas HHSC Notices Provider Advisory Committee (PAC) To enroll with Superior, call 1-800-964-2777. Application For Service Application Submission Options: Mail. (Medication Benefits) Other medically necessary pharmacy services or products are covered consistent with VDP guidance. Prior authorization is NOT required for any urgent/emergent inpatient admissions that were not prior scheduled. Unauthorized services will not be reimbursed. For notification of inpatient admission by service area throughout the state of Texas for all Medicaid and CHIP programs, please reference the phone and fax numbers below: Concurrent utilization review to determine the medical necessity for inpatient days for a hospitalized patient is completed within one (1) business day of receipt. For more information about External Medical Reviews, please visit theComplaints and Appeals webpage. Standard Prior Authorization Request - Incomplete or Insufficient Documentation. The MyPlan App. Respiratory Therapy . Notification of non-elective inpatient admissions is required no later than the close of the next business day. You may name someone to represent you by writing a letter to Superior telling us the name of the person you want to represent you. Description of service; Start date of service; End date of service; Service code if available (HCPCS/CPT) Diagnostic Imaging (CT, CTA, MRI, MRA, PET), *For Medicaid STAR, CHIP and STAR+PLUS (non-STAR+PLUS HCBS Waiver) members. These requests must be submitted to the appropriate fax number for prior authorization requests. Sanford Health Plan has a list (formulary) of FDA approved brand name and generic medications that are covered by the Plan. You can fax your forms to 1-844-303-1382. DME Criteria If your user ID is not working, please contact Availity Client Services at 1-800-AVAILITY (1-800-282-4548). Sanford Health Plan's decision is based on a combination of medical necessity, medical appropriateness, and benefit limits. As a local nonprofit health plan, Community Health Choice gives you plenty of reasons to join our Community. To request an authorization, Send us a message. All inpatient confinements do require notification of the admission no later than the next business day after the date of admission. Si tiene problemas para leer o comprender esta o cualquier otra documentacin de UnitedHealthcare Connected de MyCare Ohio (plan Medicare-Medicaid), comunquese con nuestro Departamento de Servicio al Cliente para obtener informacin adicional sin costo para usted al 1-877-542-9236 (TTY 711) de lunes a viernes de 7 a.m. a 8 p.m. (correo de voz Members enrolled in STAR, STAR+PLUS, STAR Kids, Medicaid RSA and STAR Health are eligible for this program. Find out how to use it here. Prior authorization program Prior authorization for services such as: procedures, habilitative, rehabilitation, skilled nursing facility, home care, hospice, personal care attendant, and dme. Report a concern or potential health care fraud, waste and abuse (FWA) and FWA hotline at 877-824-7123. Globally, cases rose to 83,832,334 and 1,824,590 deaths. If you should have portal concerns and need technical support, then you can contact 1-877-814-9909. b. The Superior Member Connections staff can teach you how to use Superiors services. Health Partners Plans is proud to work with you and the thousands of PCPs, specialists, dentists and vision care and other providers who make up our network. Box, 935, Jerusalem, 91010. Prior authorization does not guarantee the Plan will cover the service and will be based on the Members benefit plan and eligibility. This form is for precertification of HPI's New England business only, with the following exceptions: Dartmouth Hitchcock employees and dependents receiving If you have any questions please contact us at the phone number listed on the back of your identification card. Authorization phone assistance is available on weekdays from 8am 5pm in all time zones in Texas. Contracted providers can be found in our online provider directory. Find a medication. If you have an emergency or crisis, call 9-1-1 or visit the nearest hospital or emergency room. All you need is a phone to join our four virtual meetings in 2022. A State Fair Hearing is for Superior members who disagree with an appeal decision made by Superior to deny a service. This is a free service and includes American Sign Language. The links below will guide you to the information and resources that make managing insurance plan tasks simple and convenient. Fax: (605) 328-6813, Pharmacy Management 22272. (April 1 September 30). Billing & EDI. When submitting a request for prior authorization or to provide notification of an inpatient admission by fax, phone, or Superiors Secure Provider Portal, the Tax Identification Number (TIN) and National Provider Identifier (NPI) that will be used to bill the claim after the authorized service is provided must be supplied. P.O. Team members are available from 8 a.m. to 5 p.m. Central Standard Time, Monday through Friday. HNAS became a wholly owned subsidiary of HealthNow New York Inc., in 2006 and is a nationally recognized group benefit plan administrator. Some medications may require prior authorization, and may have clinical prior authorization edits or other limitations consistent with FDA recommendation for safe and effective use. The provider portal includes notation of required fields for submission of all necessary information for a complete authorization request. Geisinger Health Plan may refer collectively to Geisinger Health Plan, Geisinger Quality Options Inc., and Geisinger Indemnity Insurance Company, unless otherwise noted. Phone: (800) 805-7938 Just call the phone number listed below to learn more. Many Superior members may need behavioral health services. See comments Prior Authorization . *Note: Align powered by Sanford Health Plan Pharmacy information is located here. Refer to that website for details here. Forms Review of the prior authorization criteria is completed annually. These trips do NOT include ambulance trips. If you do not ask for the External Medical Review within 120 days, you may lose your right to an External Medical Review. Oncology treatment (chemotherapy and radiation) must be submitted by the provider through eviti| Connect at, High Tech Imaging for select members and health plans to be submitted thru eviCore Provider Portal link, Medication (Pharmacy) Prior Authorization, A provider feels it is medically necessary; or. To request an authorization, find out what services require authorization, or check on the status of an authorization, visit our secure Provider web portal. Service Coordination is available for members in the programs listed below: If you have Medicaid or CHIP benefits, you can call one of the following managed care helplines to get information or ask questions about the program, benefits or to choose a health plan. View our directory to find additional contact information and helpful services. HPI Online Precertification Form. Request Network Participation, Non-Contracted Providers Only, Add a Provider to an Existing Group Contract, Add a Practice Location to an Existing Contract, Practice Improvement Resource Center (PIRC), Updating Provider Demographic Information, Effective 1/1: Electronic Prescribing of Controlled Substances Required, Effective September 1, 2021: Benefit Changes to Total Disc Arthroplasty for Medicaid and CHIP, Effective July 15, 2021 through December 31, 2021: Temporary Relaxation of Prior Authorization Requirements for DME, Orthotic, and Enteral/Parenteral Nutrition and Medical Supplies, Javelina legend and NFL hall of famer Darrell Green gives back to Kingsville, Superior HealthPlan, Pro Football Hall of Famer Darrell Green Help Make First Back-to-School Community Fair & Fest in Kingsville a Success, Provider Notice of Adverse Benefit Determinations, Superior to Override Timely Filing for Claims Impacted by Texas Medicaid Healthcare Partnerships (TMHP) Eligibility Verification Issues, 2021 Prior Authorization Denial and Approval Rates CHIP (PDF), 2021 Medicaid Prior Authorization Annual Review Report (PDF), 2021 Medicaid Prior Authorization Change Log (PDF), 2020 Medicaid Prior Authorization Annual Review Report (PDF), 2020 Medicaid Prior Authorization Change Log (PDF). Amendments to the 2002 Ethical Principles of Psychologists and Four in ten likely voters are The member has tried and failed the formulary option(s). Please see below to learn more about the prior authorization process and what services require prior authorization. Depending on a patient's plan, you may be required to request a prior authorization or precertification for any number of prescriptions or services. You can also call 24 hours a day, 7 days a week for questions or for help getting emergency behavioral health services. Criminals may also be using phone number masking tools to conceal their phone numbers or to emulate the NDDoH public health hotline (866-207-2880). A reasonable opportunity for physician peer discussion (Peer to Peer)is offered prior to adverse determination on all prior authorization requests, including all urgent, standard, and Medicaid incomplete prior authorization requests. If a contracted provider is available for provision of the requested service, the prior authorization request may be denied with redirection to a contracted provider. If you are a provider and need to reach an Account Manager in your region, call the phone number below that is specific to your area, or visit the Find My Account Manager webpage., Texas Health and Human Services Commission (HHSC), Texas Ombudsman Managed Care Assistance Team. Any COVID-19 test ordered by your physician is covered by your insurance plan. THP Members, do you have other health coverage? Follow the step-by-step instructions below to design your BCBS pre-authorization request form 89 075 10 15 15: Select as requests are managed by the health plan. To ensure continued access for current e-referral users. Remember, a request for prior authorization is not a guarantee of payment. Requesting providers must initiate a request for prior authorization for non-urgent health-care services prior to delivering the requested service, medical supply equipment or clinician administered drug. The Health Plan (THP) Welcomes New Labcorp Draw Center in Wheeling, WV Join our Member Advisory Committee. SCAN also contracts with the California Department of Health Care Services for Medicare/Medi-Cal eligible beneficiaries. If a medication is not on the formulary, an exception can be made if: For medications to be considered for coverage, they must be: Sanford Health Plan staff are available by calling the appropriate number below. If you disagree with Superiors internal health plan appeal decision, you also have the right to ask for an External Medical Review at the same time you request a State Fair Hearing. The following services and medications require prior authorization. Millions of educators, students and parents use Remind to connect with the people and resources that help them teach and learn. Below is a list of Superior office locations and phone numbers in Texas. (Medication Benefits) Free dental checkups starting at 6 months of age. Please refer to the UnitedHealthcare Administrative Guide for program details and required protocols. You can also request any materials on this website in another format, such as large print, braille, CD or in another language. Are you receiving emails from SCAN and you want them to stop? Updated January 1, 2021. Need Member Help Logging In? The member/patient receives a written notice of the request for submission of the incomplete clinical information. Prior authorization is the urgent or non-urgent authorization of a requested service prior to receiving the service. Medical authorizations should be directed to 1-888-251-3063. c. Claims issues can be directed to 1-800-727-7536, option 4. d. Commercial, Self-funded or Sanford Group Health members (800) 805-7938. And when you do, you'll get access to tools, tips and programs to help you reach your healthiest you. - Provides current status and timely notifications, Medical Services Prior Authorization Request Form, Medicare Advantage (Align) Medical Services Prior Authorization request form, Medication (Pharmacy) Prior Authorization Request or Formulary Exception Form, Synagis Prior Authorization Form (for Synagis ONLY). Superior Member Advocates can help members get access to care. All rights reserved. Pharmacy Prior Authorization Assistance 1.877.908.6023. For the latest on Covid-19 and expanded At-Home COVID test reimbursement click here. After hours, you may leave a message on the confidential voice mail and someone will return your call the following business day. *Please note: Refer to the SHP Pharmacy Information page for medications requiring prior authorization. You or your representative must ask for the External Medical Review within 120 days of the date Superior mails the letter with the internal appeal decision. Prior authorization is the review of the medical necessity and appropriateness of selected health services before they are provided. Approval or denial of prior authorization requests received by phone will be finalized immediately, during the call. Physical and behavioral health emergencies, life threatening conditions and post-stabilization services do not require prior authorization. These trips include rides to the doctor, dentist, hospital, pharmacy and other places you get Medicaid services. Our staff speaks English and Spanish. Fax: (701) 234-4568. You can call from 8 a.m. - 8 p.m., Monday through Friday. Texas Health Steps gives your child: Read more about this program on the Texas Health Steps website or call Member Services at the phone numbers listed below., Superiors Medical Ride Program (NEMT services) provides transportation to non-emergency health-care appointments for members who have no other transportation options.
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