Payment Policy Posting and Updates
Date: 12/20/24
Superior HealthPlan, Ambetter from Superior HealthPlan and Wellcare By Allwell present new and existing payment policies as detailed below. As a result, the following policies have been posted on Superior’s Clinical, Payment and Pharmacy Policies webpage for awareness, prior to implementation:
POLICY | EFFECTIVE DATE | APPLICABLE PRODUCTS | NEW POLICY OVERVIEW OR UPDATED POLICY REVISIONS |
TX.CC.PP.011 Code Editing Policy | 12/15/24 | Health Insurance Marketplace (Ambetter from Superior HealthPlan) Medicare (Wellcare By Allwell [HMO, HMO D-SNP]) | Coding Reminder: Billing for Electrodes Consistent with the health plan code editing pre-payment policy, claims will be denied when A4556 (Electrodes, [e.g., apnea monitor], per pair) is billed, and diagnosis code(s) on the claim indicate it has been billed as a transcutaneous electrical nerve stimulation (TENS) electrode. TENS supply allowance (A4595) is an all-inclusive code and includes items such as electrodes (A4556). |
CC.PP.501 30 Day Readmission | 02/01/25 | Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), CHIP | Post Pay reviews will be performed for inpatient readmissions determined to have been inappropriate or preventable. Readmission claims will be determined to be overpayments when the readmission:
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To review all policies, please visit Superior’s Clinical, Payment and Pharmacy Polices webpage. For questions or additional information, please contact Provider Services at:
- 1-877-687-1196 (Ambetter from Superior HealthPlan)
- 1-877-391-5921 (Medicaid [STAR, STAR Health, STAR Kids, STAR+PLUS], CHIP)
- 1-800-977-7522 (Wellcare By Allwell - Medicare HMO)
- 1-877-935-8023 (Wellcare By Allwell - Medicare HMO DSNP)