Medicaid Superior Health Plan Providers

Date:

Are Video Visits With A Primary Care Doctor Online Covered By Superior Healthplan

Superior HealthPlan Texas Medicaid Rewards | Earn Extra Money with My Health Pays®

Most insurers provide coverage for video visits at the same cost as in-person visits. You can search on Zocdoc specifically for Doctors in San Antonio who accept Superior HealthPlan for video visits by selecting your carrier and plan from the drop-down menu at the top of the page. We recommend you check with your insurance carrier directly to confirm your coverage and out of pocket costs for video visits.

Medicare Advantage Vision Providers And Copays

THP vision providers may not collect a copay from Medicare Advantage members for Medicare covered eye exams or nonMedicare routine vision exams .

Vision benefits are as follows for Medicare Advantage members:

Covered services include:

  • Outpatient physician services for the diagnosis and treatment of diseases and injuries of the eye, including treatment for age-related macular degeneration. Original Medicare doesnt cover routine eye exams for eyeglasses/contacts.
  • For people who are at high risk for glaucoma, THP will cover one glaucoma screening each year. People at high risk for glaucoma include: people with a family history of glaucoma, people with diabetes, African-Americans who are age 50 and older and Hispanic Americans who are 65 or older
  • For people with diabetes, screening for diabetic retinopathy is covered once per year
  • One pair of eyeglasses or contact lenses after each cataract surgery that includes insertion of an intraocular lens

Non-Medicare covered routine exams and eyewear, provided through the plans vision administrator and subject to plan coverage limits:

  • Vision exam covered every year.
  • Routine eyewear covered every 2 years.

$0 copay for Medicare-covered eye exam.

$0 copay for one standard pair of Medicare-covered eyeglasses or contact lenses after cataract surgery.

$0 copay for non-Medicare covered/routine Vision exam.

$0 copay non-Medicare covered/routine eyewear.

Plan coverage limit for non- Medicare covered/routine eyewear:

Support For Superior Members Affected By Fire In Washington County

If you are a member of Superior HealthPlan and have been impacted by the fire in Washington County, there are services available to help you.

All Superior members who have been impacted by the fire in Washington County and need to replace necessary medical equipment, services, or supplies should seek replacement through any available supplier. If you cannot find a supplier, call Member Services to find one for you. Your supplies will be replaced even if you are temporarily outside of the county in which you live.

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To Be Eligible For This Plan You Must Meet The Following Requirements:

  • Be age 21 or older, and
  • Live in either the Bexar, Dallas or Hidalgo County, and
  • Have both Medicare Part A and Medicare Part B, and
  • Are a United States Citizen or are lawfully present in the US, and
  • You are eligible for Medicaid and at least one of the following:
  • Have a physical disability or a mental disability and qualify for Supplemental Security Income , or
  • Qualify for Medicaid because you receive Home and Community Based Services waiver services and
  • You are NOT enrolled in one of the following 1915 waiver programs:
  • Community Living Assistance and Support Services
  • Deaf Blind with Multiple Disabilities Program
  • Home and Community-Based Services
  • Texas Home Living Program
  • This information is available for free in other languages. For more information, call Member Services at 1-866-896-1844. Hours are 8 a.m. to 8 p.m., Monday through Friday. After hours, on weekends and on holidays, you may be asked to leave a message. Your call will be returned the next business day. TTY users call 711.

    We are here to help you get the healthcare you need, when you need it and to keep you healthy.

    Now is the time to think about what you want to get out of your health care plan. It is your choice!

    More information on Medicare benefits and services can be found 24 hours a day, seven days a week at www.medicare.gov or call 1-800-MEDICARE , TTY users call: 1-877-486-2048. Calls to this number are free, 24 hours a day, 7 days a week.

    We Provide Texas Healthcare Programs That Empower You Your Family And Your Community

    Discover Superior HealthPlan

    Superior HealthPlan has a commitment to improving the health of the community one individual at a time through affordable and reliable healthcare plans. We have an approach to healthcare in Texas that can meet the needs of each person we serve.

    Superior HealthPlan is a managed healthcare company that provides healthcare to 1.7 million Texas residents. We began in El Paso in 1999 today, Superior has 8 office locations and serves members in all 254 counties across the state.

    Superior works with the State of Texas Health and Human Services to bring you STAR , Childrens Health Insurance Program , CHIP Perinatal Care and STAR+PLUS and STAR Health. We have been the exclusive provider of STAR Health since 2008.

    Since 2015, Superior HealthPlan has received a score of 3.5 or higher on a 5.0 scale on the National Committee for Quality Assurance Medicaid Health Insurance Plan Ratings. This includes a score of 3.5 for 2021.

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    Superior Healthplan Star+plus Medicare

    Superior HealthPlan STAR+PLUS Medicare-Medicaid Plan is a Medicare-Medicaid Plan made up of doctors, hospitals, pharmacies, providers of long-term services and supports, and other providers. It also has Service Coordinators and service coordination teams to help you manage all your providers and services. They all work together to provide the care you need.

    Accessing Care: Medicaid And Chip Members

    To choose a doctor or Primary Care Provider , call Superior Member Services. They can give you the name, address and phone number of a doctor or specialist. They can also help you get a provider’s:

    • Professional qualifications
    • Demographics

    More information on how to choose a PCP can be found in your member handbook.

    To find out which nursing facilities are in Superior’s network, you can call us at 1-877-277-9772 or search our Find a Provider online tool.

    If you are a STAR Kids or STAR+PLUS member and are dual eligible, Medicare pays your doctor. That means you do not need to choose a PCP in STAR Kids or STAR+PLUS. You can keep seeing the Medicare doctor you have been seeing for your health care.

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    How Can I Make A Same

    On average, patients who use Zocdoc can search for a Primary Care Doctor in San Antonio who takes Superior HealthPlan insurance, book an appointment, and see the Primary Care Doctor within 24 hours. Same-day appointments are often available, you can search for real-time availability of Doctors in San Antonio who accept Superior HealthPlan insurance and make an appointment online.

    Ambetter From Superior Healthplan

    Superior HealthPlan: Medicaid and CHIP Coverage to Fit Your Needs

    The Health Insurance Marketplace is an online shopping mall of healthcare plans. Ambetter from Superior HealthPlan offers affordable healthcare coverage for individuals and families. Depending on your family size and income, you may even qualify for help to pay your monthly premium.

    Learn how we transform the health of the community, one person at a time, by visiting our Members First webpage now.

    Centene Corporation is a leading healthcare enterprise committed to helping people live healthier lives. The Company takes a local approach with local brands and local teams to provide fully integrated, high-quality, and cost-effective services to government-sponsored and commercial healthcare programs, focusing on under-insured and uninsured individuals. Centene offers affordable and high-quality products to nearly 1 in 15 individuals across the nation, including Medicaid and Medicare members as well as individuals and families served by the Health Insurance Marketplace, the TRICARE program, and individuals in correctional facilities. The Company also provides a variety of specialty services focused on treating the whole person. Centene focuses on long-term growth and value creation as well as the development of its people, systems, and capabilities so that it can better serve its members, providers, local communities, and government partners.

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    Find A Medicare Doctor Or Pharmacy

    A doctor is a trusted partner and is key to getting the care you need, when you need it. Use the Find A Doctor Tool to search for in-network Medicare doctors, hospitals, pharmacies, and other providers.

    Consider choosing a doctor or provider thats in-network. This will help keep your healthcare costs affordable. If you need help finding an in-network doctor or provider, give us a call. Were here to help.

    Provider And Pharmacy Directory Information

    • Provider & Pharmacy Directory Information, HMO – – coming soon

    If you have questions, please contact Member Services.

    Wellcare By Allwell from Superior HealthPlanForum II Building7990 IH 10 West, Suite 300San Antonio, TX 78230

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    Wellcare is the Medicare brand for Centene Corporation, an HMO, PPO, PFFS, PDP plan with a Medicare contract and is an approved Part D Sponsor. Our D-SNP plans have a contract with the state Medicaid program. Enrollment in our plans depends on contract renewal.

    Wellcare by Allwell includes products th

    Wellcare is the Medicare brand for Centene Corporation, an HMO, PPO, PFFS, PDP plan with a Medicare contract and is an approved Part D Sponsor. Our D-SNP plans have a contract with the state Medicaid program. Enrollment in our plans depends on contract renewal.

    Wellcare by Allwell includes products that are underwritten by Superior HealthPlan, Inc. and Superior HealthPlan Community Solutions, Inc.

    Every year, Medicare evaluates plans based on a 5-star rating system.

    Out-of-network/non-contracted providers are under no obligation to treat Plan members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

    Value-Added Items and Services are not plan benefits and are not covered by the plan. Plan enrollees are responsible for all costs.

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    Cms Requests Provider Demographic Data Review/attestation In Nppes

    The Health Plan strives to maintain an accurate provider directory to assist our members in locating a provider to treat their health care needs.

    The Centers for Medicare and Medicaid has made it their goal to increase the accuracy of provider directories.

    CMS is requesting that providers review their demographic information in the National Plan and Provider Enumeration System registry, make necessary corrections and attest to the accuracy of the data.

    The purpose is to reduce the need for payers, such as The Health Plan, to contact providers to verify demographic directory data.

    NPPES has recently added the ability to enter multiple provider addresses where providers see patients for appointments.

    Access the NPPES NPI registry here to verify and/or update provider demographic information and attest to the accurateness of the information.

    There is no cost to providers to edit and certify NPPES information.

    Please contact your practice management consultants should you have questions. Click here to access your reps contact information.

    Serving The Following Counties*:

    Discover Superior HealthPlan

    Aransas, Armstrong, Atascosa, Bailey, Bandera, Bastrop, Bee, Bexar, Blanco, Borden, Bosque, Briscoe, Brooks, Burnet, Caldwell, Calhoun, Cameron, Castro, Cochran, Coke, Collin, Colorado, Comal, Crosby, Dallas, Denton, DeWitt, Dickens, Dimmit, Donley, Duval, El Paso, Erath, Fayette, Fisher, Floyd, Garza, Gillespie, Glasscock, Goliad, Gonzales, Grimes, Guadalupe, Hale, Hamilton, Hays, Hidalgo, Hill, Hockley, Hunt, Irion, Jack, Jim Hogg, Jim Wells, Karnes, Kendall, Kenedy, Kent, Kimble, Kleberg, La Salle, Lamb, Lee, Leon, Limestone, Lubbock, Lynn, Martin, Mason, Maverick, McCulloch, McMullen, Medina, Milam, Mills, Mitchell, Navarro, Nolan, Nueces, Palo Pinto, Real, Refugio, Rockwall, San Saba, Shackelford, Somervell, Starr, Sterling, Swisher, Tarrant, Terry, Throckmorton, Uvalde, Willacy, Williamson, Wilson, Zapata and Zavala counties

    *Product offerings vary by area.

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    Superior Healthplan Texas Medicaid & Chip Benefits & Services

    We are here to ensure you have everything you need to know about your Texas Medicaid Plan and CHIP benefits, services, co-pays and more.

    Superior HealthPlan provides benefits and services for Medicaid, CHIP, and health insurance in Texas. In this section, you can learn about the Texas Medicaid benefits, pharmacy services and value- added services Superior HealthPlan offers.

    Need help understanding these Texas Medicaid benefits and services? Please contact Superior Member Services.

    You can also view more information about Superior HealthPlan and health insurance in Texas in our Member Handbook.

    All services must be medically necessary in order to be covered by Medicaid in Texas. Your Primary Care Provider will work with you to make sure you get the services you need. These services must be given by your Primary Care Provider or by another provider that your Primary Care Provider refers you to.

    Some services may:

    • Need a doctors order.
    • Need prior approval.

    *Some Medicaid members may not have all the benefits listed.

    Your Texas Medicaid plan from Superior will determine your coverage and eligibility for specific treatments, medications, and services. Please contact Superior HealthPlan with any questions you may have regarding your eligibility.

    Special Services For Star Medicaid Pregnant Members

    • Start Smart® For Your Baby Program – If you stay for an entire baby shower, or download the Wellframe mobile app and engage for 30 days, you can get extra benefits* like: – A diaper bag and diapers when you complete the Notification of Pregnancy form – A convertible baby car seat when you complete the NOP form and go to one prenatal visit within your first trimester or 42 days of enrollment with Superior
    • Up to $100 My Health Pays® rewards each year for completing prenatal and postpartum visits. Visit My Health Pays ® for more rewards information.
    • Extra dental benefits. This includes up to $250 for pregnant women ages 21 and older.
    • Telephonic outreach, education and support services offered to reduce the health risks associated with smoking during pregnancy through Superiors Puff-Free Pregnancy program.

    *Restrictions and limitations may apply.Value-added Services are extra health care services offered by Superior. Services may vary by area. These services are valid through 8/31/22.

    Read Also: Ga Medicaid Eligibility Income Chart

    Contact Us Online Form

    The Contact Us form will send your message to Superior HealthPlan as an email. The email is not encrypted and is not transmitted in a secured format. By communicating with Superior through email, you accept the risks associated thereof. Superior does not accept responsibility or liability for any loss or damage arising from the use of email. To ensure the safety of your protected health information , please send us a message through the Secure Member Portal or Provider Portal, or you can call us at the Member Services number on the back of your Superior ID card to speak directly to a customer service representative.

    Advantages In Joining Superior

    Medication Tips for Superior HealthPlan STAR PLUS MMP Members
    • Getting all of your covered Medicare and Medicaid services from Superior STAR+PLUS MMP. You wont pay extra to join our health plan.
    • Having both an individual Service Coordinator and service coordination team who will work with you, and with your care providers, to come up with a Plan of Care specifically designed to meet your health needs. Your Service Coordinator will be responsible for coordinating the services you need such as informing your doctors about the medicines you take and ensuring that your test results are shared with you.

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    Introducing Wellcare By Allwell

    Wellcare By Allwell is Centene Corporation’s Medicare Advantage product in Texas, offering plans with prescription drug coverage.

    Wellcare By Allwell was created to provide affordable and quality Medicare coverage to help members get the care they need to feel their best.

    Wellcare By Allwell plans are designed to:

    • provide extra benefits not covered by Original Medicare such as hearing, vision or dental services.
    • provide affordable access to doctors, nurses and specialists.
    • provide coverage for prescriptions drugs.*

    *Benefits may vary by plan.

    Contracted Medical Or Ancillary Providers

    Contracted providers can use this form to add a product, provider or location to an existing contract. Please note, if you are affiliated with a third party Delegate Manager, all changes must be made at the request of the Delegate. Contact your Delegate Manager for additional information.

    NOTE: The following requests should be submitted by contacting your Account Management Representative.

    • Medical Providers and Groups who want to add a new practice location and are currently credentialed by Superior or
    • Ancillary providers who want to add a new practice location that will operate under the same state license and TIN/NPI combination.

    , or visit Superior’s Provider Resources webpage to review a current listing of additional information.

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    How Can I Book An Appointment Online With A Superior Healthplan Primary Care Doctor In San Antonio

    Zocdoc is a free online service that helps patients find Superior HealthPlan Doctors in San Antonio and book appointments instantly. You can search for Superior HealthPlan Doctors in San Antonio by symptom or visit reason. Based on that information, youll see a list of providers who meet your search criteria, along with their available appointment slots.

    There Are Many Advantages In Joining This Type Of Plan Including:

    We Do More For Members
    • Getting all of your covered Medicare and Medicaid services from Superior HealthPlan STAR+PLUS Medicare-Medicaid Plan . You wont pay extra to join our health plan.
    • Having both an individual Service Coordinator and service coordination team who will work with you, and with your care providers, to come up with a Plan of Care specifically designed to meet your health needs. Your service coordinator will be responsible for coordinating the services you need such as informing your doctors about the medicines you take and ensuring that your test results are shared with you.

    Read Also: How Can I See If I Qualify For Medicaid

    How Can I Find A Top

    You can use Zocdoc to find Superior HealthPlan Doctors in San Antonio who are highly rated by other patients. These ratings are based on verified reviews submitted by real patients. Every time a patient completes an appointment booked on Zocdoc, theyre invited to review their experience. Each review must comply with Zocdocs guidelines.

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