Submitting Complaints
ONLINE
Providers can access and submit the Online Complaint Form by visiting
SuperiorHealthPlan.com/contact-us/complaint-form-information.html
(scroll to the bottom of the web page to begin).
MAIL OR FAX
The complaint form can be printed, completed
and mailed or faxed to:
Mail: Superior HealthPlan
ATTN: Complaint Department
Fax:
CALL
Providers may also file a verbal complaint by calling
Complaints
Superior HealthPlan has an online complaint submission form available through the
Superior website. The online form allows providers to file complaints for resolution.
SuperiorHealthPlan.com
Superior will answer
complaints within
date the complaint is
received.
Most of the time, Superior can
assist right away. There is no time
limit for filing a complaint with
Superior. Providers can also submit
a complaint to Texas Health and
Human Services (HHS) by calling
Please Note: The online feature and written complaint process does not replace or include inquiries or
appeals related to Claims or Medical Necessity Appeals. For those services, please continue to contact
Superior’s applicable departments by visiting SuperiorHealthPlan.com.
Provider Services:
How to Register for
Payspan
Registration
registration code.
Visit PaySpanHealth.com and click Register Now.
Enter the unique registration code and click Submit.
OR
Enter the registration code, Provider ID Number
(PIN), Tax ID Number (TIN) or Employer
Identification Number (EIN) and National Provider
Identifier (NPI) and click Start Registration.
SuperiorHealthPlan.com
Provider Services:
Payspan is a free, secure online tool that gives providers the option to:
Improve cash flow
Maintain control over bank accounts
Settle claims electronically
Match payments to statements quickly
Manage multiple payers
Create custom reports
View remittance advice online
Registering for Payspan online is simple and only takes about 10 minutes.
Follow the instructions below to begin.
Sign Up for Superior’s
Provider Newsflash
Don’t miss important provider news and updates! Superior’s Provider Newsflash is an
e-newsletter emailed every two weeks to subscribing providers. Take a moment to subscribe
today and start to receiving news relevant to your area and/or Superior products.
SuperiorHealthPlan.com
Stay up-to-date with the latest Provider News!
Follow the instructions below to begin.
Visit SuperiorHealthPlan.com.
Click on the For Providers tab.
Click on Provider News & Information found on the
left side bar navigation menu.
Under Provider News on this page, click Sign up
to update your information to receive important
news and updates on Superior HealthPlan to
begin the process.
Enter provider information and select Submit when
complete.
Providers may also view archived newsletters by visiting
SuperiorHealthPlan.com/providers/provider-news.html.
Provider Services:
Sign Up for Superior’s
Provider Newsflash
Don’t miss important provider news and updates!
Superior’s Provider Newsflash is an e-newsletter
emailed every two weeks to subscribing providers.
Take a moment to subscribe today and start to
receiving news relevant to your area, specialt y
and/or Superior products.
SuperiorHealthPlan.com
© 2019 Superior HealthPlan. All rights reserved.SHP_20174071G
Stay up-to-date with the latest Provider News!
Customized news may include, but is not limited to:
To sign up for Superior’s Provider Newsflash, update your information or view current
news, please visit SuperiorHealthPlan.com/provider-news.html.
Provider Services: 1-877-391-5921
Texas Health and Human Services (HHS)
requirements
Mandatory trainings
Billing and claims information
Superior policy updates
After-Hours Telephone
Accessibility Standards
The Texas Health and Human Services (HHS) Uniform Managed Care Contract sets
accessibility standards that a Primary Care Provider (PCP) must follow, to allow patients
to reach them by phone after normal business hours. Superior audits PCP offices after
business hours to determine compliance with these standards. Below are the basic
accessibility requirements to help you assess your current after-hours availability.
SuperiorHealthPlan.com
What meets the standards?
A bilingual answering service, which can contact the PCP or another designated medical practitioner.
A bilingual answering machine message that directs the patient to call another number to reach the PCP or
another designated provider (not another answering machine).
Office telephone systems that transfer calls to another location where someone will answer the telephone and
What doesn’t meet the standards?
The office telephone is not answered after office hours.
The answering machine message tells patients to leave a message.
The answering machine message is not bilingual (English and Spanish).
The answering machine message instructs patients to go to an Emergency Room for any services needed.
Need more information on accessibility standards?
Review Superior’s provider manual at
SuperiorHealthPlan.com/providers/training-manuals.html.
Provider Services:
Simplify Prior Authorization
Process
Submit prior authorization requests using
the “Smart Sheets” feature with prompts
for required clinical information.
View Multiple TINs
One point of entry allows for quick and easy access to
Superior HealthPlan member information for multiple TINs/practices.
Access Daily Patient Lists from One Screen
One concise view allows Primary Care Providers to scan
patient lists for details such as Superior member
eligibility and care gaps.
Manage Batch Claims for Free
Submit and manage claims, including batch and
view detailed Electronic Funds Transfer (EFT)
payment history.
Utilize Additional Features to
Streamline Office Operations:
• View patient demographics and history.
• Use the secure messaging feature to
communicate with Superior.
• Update provider demographics.
Get Started Now!
Visit Provider.SuperiorHealthPlan.com and click Create
an Account. Have your tax ID number ready during sign up.
Secure
Provider Portal
Manage patient administrative
tasks quickly and easily.
Secure Provider Portal
QUESTIONS?
Contact Superior
HealthPlan at
1-877-391-5921
PROTECTED,
CONVENIENT
ACCESS
AT YOUR
FINGERTIPS
Access
Daily Patient Lists
from One Screen
Manage
Batch Claims
for Free
View
Multiple
TINs
Simplify
Prior
Authorization
Process
Check
Patient Care
Gaps
Streamline
Office
Operations
SuperiorHealthPlan.com
Payspan
Get Paid Faster
Superior HealthPlan offers Payspan, a free solution that helps providers simplify the
payment tracking and transfer process.
Visit PaySpanHealth.com and click Register.
You may need your National Provider Identifier (NPI) and Provider
Tax ID Number (TIN) or Employer Identification Number (EIN).
Electronic Funds Transfer (EFT) Solution
Improve cash flow
by getting payments faster.
Settle claims electronically
through Electronic Fund
Transfers (EFTs) and Electronic
Remittance Advices (ERAs).
Eliminate re-keying of
remittance data
by choosing how you want to
receive remittance details.
Create custom reports
including ACH summary reports,
monthly summary reports, and
payment reports sorted by date.
Maintain control over
bank accounts
by routing EFTs to the bank
account(s) of your choice.
Match payments to
statements quickly
and easily re-associate
payments with claims.
Manage multiple payers,
including any payers that are
using Payspan to settle claims.
SET UP YOUR
PAYSPAN
ACCOUNT
TODAY
SuperiorHealthPlan.com
Provider Services: 1-877-391-5921
Prior Authorization Guide
How to Obtain
Prior Authorization
Visit our
website for a
list of services
that require prior
authorization.
Please note:
All out-of-network services require prior authorization except emergency care,
out-of-area urgent care and out-of-area dialysis.
Failure to complete the required prior authorization or certification may result
in a denied claim.
More resources available at SuperiorHealthPlan.com/providers.html.
Pre-Auth Needed Tool
Use the Pre-Auth Needed Tool to quickly determine if a service or procedure requires prior
authorization, by visiting SuperiorHealthPlan.com/providers/preauth-check/medicaid-pre-auth.html.
SECURE PROVIDER PORTAL
Provider.SuperiorHealthPlan.com
This is the preferred and fastest method. The provider
must be a registered user.
Submit a Prior Authorization Request
If a service requires prior authorization, submit through one of the following ways:
Provider Services: SuperiorHealthPlan.com
PHONE
After normal business hours
and on holidays, calls are
directed to Superior’s
24-hour Nurse Advice Line.
FAX
Medical
Behavioral Health
Claims
Timely filing guidelines:
95 days from date of service.
Submit claims:
Secure Provider Portal
Clearinghouses:
EDI Payor ID 68069
Mail paper claims to:
Superior HealthPlan
P.O. Box 3003
Farmington, MO
63640-3803
Prior Authorization
Use the Pre-Auth Needed
Tool on our website
to determine if prior
authorization is required.
Submit prior
authorizations:
Secure Provider Portal
Fax: 1-800-690-7030
Phone: 1-800-218-7508
Member Eligibility
Check member eligibility:
Secure Provider Portal
Provider Services:
1-877-391-5921
TTY/TDD:
1-800-735-2989
Patient Care Gaps
Find recommended
services that a member
has not completed.
1. Visit the Secure
Provider Portal.
2. Review patient
information for any
gaps in care.
3. Plan to address care
gaps during a future
appointment.
Simplify Office
Administrative Tasks
Keep this Quick Reference Guide nearby to simplify pre-visit
planning and post-visit tasks.
Quick Reference Guide
Website: SuperiorHealthPlan.com
Patient care forms
Pre-auth needed tool
Superior HealthPlan news
Provider manual
Preferred drug list
Member resources
Secure Provider Portal: Provider.SuperiorHealthPlan.com
Verify member eligibility
Access patient health records
View patient gaps
Manage prior authorizations
Submit and manage claims
Obtain provider resources
Verify member eligibility.
Check for patient care gaps and address them during upcoming office visit.
Use Pre-Auth Needed Tool to determine if prior authorization is needed before appointment.
Pre-Visit
Planning
Checklist
Provider Services: SuperiorHealthPlan.com
