Effective July 1, 2025: New Payment Policy: Inpatient Claim Billing/Coding Reviews

Date: 04/14/25

Superior HealthPlan and Ambetter from Superior HealthPlan present a new payment policy to communicate payment policy for inpatient claim billing and coding reviews. As a result, the following policy has been created, and is posted on Superior’s Clinical, Payment and Pharmacy Policies webpage for review, prior to its implementation:

POLICY	EFFECTIVE DATE	APPLICABLE PRODUCTS	NEW POLICY OVERVIEW OR UPDATED POLICY REVISIONS
Inpatient Claim Billing/Coding Review TX.CC.PI.04	July 1, 2025	Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), CHIP, Ambetter from Superior HealthPlan	Review of Inpatient claims that are greater than $25,000 allowable charges; and/or inpatient claims that qualify for DRG outlier.

To review all clinical payment or payment policies, please visit Superior’s Clinical, Payment and Pharmacy Polices webpage.

For questions or additional information, please contact Provider Services at:

• 1-877-391-5921 (Medicaid [STAR, STAR Health, STAR Kids, STAR+PLUS] and CHIP)
• 1-877-687-1196 (Ambetter from Superior HealthPlan)