- THCA

Volume XXXI, Number 6
June 2016

THCA Meets with Superior HealthPlan on Payment Issues

Members of THCA’s Data / Reimbursement Committee recently met by conference call with representatives from Superior HealthPlan to discuss providers’ Medicaid Managed Care accounts receivables balances. Specifically, the purpose of the meeting was to have them report to us what they are doing to address current A/R levels, (2) what their plans are going forward to fix the systemic problems, and (3) for THCA’s reimbursement experts to provide them with feedback regarding their plans. The call was a productive one, and both parties felt that it was time well spent.

In a follow up to that call, Superior has provided THCA with the following updates:

They are developing a FAQs document of claims issues for providers to reference. They must get approval from the Health and Human Services Commission (HHSC) before it can be disseminated but are hopeful that this will happen shortly.
Providers should use their point of contact to if they would like notification language added into their contract that specifies that a recoupment letter sent allowing the NF 45-120 days (depending on preference) for the opportunity to send in a refund versus having claims recouped. This would only be for large recoupments, not daily adjustments.
Superior is meeting internally on the timing of getting its portal updated to include applied income, to show that was deducted from claims, and to show EOPs updated with the RUG that was paid for the claims.
Providers who want to request special reports to be run to help research problem claims should use their point of contact to request the report and to set up a meeting to review any outstanding claim issues that need to be resolved.
Superior provided THCA with a listing of contacts by facility, for each centralized billing office, etc. They also provided THCA with a document describing the escalation process to help resolve issues related to claims.

THCA plans to schedule similar meetings with the remaining MCOs to resolve issues regarding timely and accurate payment of claims. We will keep you apprised of further developments.

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If you have any questions about the THCA Commitment to Care Initiative or would like to share your facilities successes please contact Gloria Bean-Williams by email or call (512) 458-1257.