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HHSC Notice: Erroneous Termination of Superior Member Coverage

Date: 08/21/23

A recent notice from the Texas Health and Human Services Commission (HHSC) indicated that approximately 10,000 Superior HealthPlan members incorrectly lost their Medicaid coverage after April 1, 2023. This error is currently being addressed by HHSC, and we anticipate the reinstatement of benefits for these members soon.

Requested Action for Providers

Member Reimbursements

  • Should members approach you with a request for refunds due to out-of-pocket expenses made during their period of interrupted coverage, they are entitled to full reimbursement.
    • It is essential that you promptly process these refunds.
  • As indicated by HHSC, these members will continue to have coverage until their cases have been reviewed. Any services for these members provided during this period can be billed to Superior HealthPlan.

Prompt Claim Submission

  • After processing member refunds, please submit the relevant claims to Superior immediately. This swift action is crucial to avoid denials due to timely filing.

Prompt Claim Re-Submission

  • If a claim was rejected as a result of member ineligibility, please resubmit the claim for processing.
    • If a denial was received and is within 95 Days of the denial date, please submit a new claim.
    • If more than 95 Days have elapsed since the denial, please follow the process for submitting a reconsideration, outlined in the Claims Reconsiderations section of the Superior HealthPlan STAR, CHIP, STAR+PLUS, STAR Health and STAR Kids Provider Manual. In the reconsideration request, please indicate: Member’s eligibility retroactively reinstated.

Handling Timely Filing Denials

  • If you face a denial for timely filing, please follow the process for submitting a reconsideration, outlined in the Claims Reconsiderations section of the Superior HealthPlan STAR, CHIP, STAR+PLUS, STAR Health and STAR Kids Provider Manual. In the reconsideration request, please indicate: Member’s eligibility retroactively reinstated. Please also include the following when submitting a reconsideration:
    • Explanation of payment.
    • Documentation showing the reimbursement provided to the member for the affected dates of service.

For additional support, queries or clarifications regarding this situation, please contact your local Account Manager.