Finding services in your area such as child care. Please see below for more details on each program. The remaining 25 percent, totaling $6,981,395, is funded by the State of Texas. You may also file your complaint online by filling out a complaint form. Members can get oral interpretation services and information in other formats, like Braille, audio, or large print free of charge. Simply call Superior Member Services. Your appeal is for a service that was denied or limited that had been previously approved. The hotline is open from 8 a.m. to 8 p.m. Monday through Friday, except for federal holidays. Banks: Department of Banking 877-276-5554 File a complaint, Contractors: Texas Attorney General 800-621-0508 File a complaint, Home warranties: Texas Department of Licensing & Regulation 512-463-6599 File a complaint. Superior will acknowledge your appeal within five (5) Business Days of receipt, and complete the appeal within 30 calendar days. If you need help, Superior can help you put your appeal in writing. You can call the CHIP/Children's Medicaid Hotline and tell a customer care representative what your new address is. Superior will make a decision about your expedited appeal within one (1) Business Day, and send you a letter within 72 hours. FAX:1-866-918-2266. Update Your Contact Info with Texas Medicaid. To ask for a fair hearing, call 1-800-414-3406 or write to: TMHP Portal Security Provider Training Manual, Texas Medicaid Provider Procedures Manual, Children with Special Health Care Needs Services Program Provider Manual, Learn more about Medicaid and Your Texas Benefit Card. CSHCN Services Program Complaints Unit Fax 1-512-776-7238 Correspondence Address First-Time Claims . To ensure coverage continues, if you're eligible, report changes (contact information, pregnancy, etc.) (7 a.m. to 7 p.m. Central Time, Monday to Friday). You may attend the hearing, have someone represent you at the hearing or have a representative attend the hearing with you. We accept complaints about fraud, waste and abuse in Medicare, Medicaid and other HHS programs and from HHS employees, grantees and contractors who are reporting wrongdoing at HHS and its programs (whistleblowers) for the first time. Your provider, a friend, a relative, lawyer or another spokesperson can file an internal health plan emergency appeal on your behalf. Provides a partial approval for a covered service. If you are unhappy with Superior, you may file a complaint (PDF). Most hearings are held by telephone. Go to our online complaint system. To ensure the safety of your protected health information (PHI), 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. If Superior continues or reinstates benefits at your request and the request for continued services is not approved by the State Fair Hearing officer, Superior will not pursue recovery of payment for those services without written permission from HHS. Every report we receive is important, however, not every submission results in an investigation. Call your provider's office right away. Texas Health and Human Services (HHS) will perform the semi-annual update of the Texas Medicaid preferred drug list (PDL) on July 27, 2023. If you need help with claim rejections, issues with your account, or other questions, call the TMHP EDI Help Desk at 1-888-863-3638. If the complaint is Medicaid-related and contains sufficient provider-identifying information, a case is opened and assigned to an intake investigator. You can send an internal health plan appeal in writing to: Superior HealthPlan Have any documents related to your complaint, such as letters, bills or prescriptions, ready too. In the last fiscal year alone, the MFCU recovered more than $236 million in settlements and judgments for Texas taxpayers. Contactar la lnea directa de comunicacin del OIG es tan fcil. You may also appeal Superiors denial of a claim, in whole or in part. Austin, TX 78708, OIG fraud hotline: 800-436-6184Main number: 512-491-2000, Call the OIG Fraud Hotline if you suspect wrongdoing. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. You will need Adobe Reader to open PDFs on this site. They will follow up with you every five business days until the complaint is resolved. All rights reserved. You can ask for an External Medical Review and a State Fair Hearing, but you cannot request only an External Medical Review. Call 866-566-8989 8 a.m. to 5 p.m. Central Time, Monday through Friday and speak to someone that day. Call your provider's office right away to make sure they know you or your child are on Medicaid or the CSHCN Services Program and that they have your client ID number. Please note that collection statements are not considered bills. 5900 E. Ben White Blvd., To file your complaint, you can call Molina Healthcare Member Services at: (866) 449-6849. You or someone acting for you will receive written notice of the final External Review decision as soon as possible. If Superior thinks that your emergency appeal request does not meet the emergency appeal criteria, Superior will let you know right away. Call Superior Member Services for more information. You or your representative must ask for a State Fair Hearing within 120 days of the date of the notice telling you that we are denying your appeal with Superior. Official websites use .gov MCNA Dental: Texas Medicaid and CHIP - Free Dental Care for Children You may submit through the following methods: You can verify client eligibility using the Automated Inquiry System (AIS), the Interactive Voice Response (IVR), or through a representative by calling the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413. There are several ways to file a complaint with TDI: Superior will never retaliate against you because you filed a complaint against us, or appealed our decision. If you believe that waiting for a State Fair Hearing will seriously jeopardize your life or health, or your ability to attain, maintain, or regain maximum function, you or your representative may ask for an emergency State Fair Hearing by writing or calling Superior at 1-877-398-9461. The initial call to the hotline generally takes about five minutes, includes basic questions about the allegation and determines if a complaint needs further investigation. Note: TDI regulates Medicare supplement insurance and can help with questions or complaints. Texas Health Steps8778478377 Christian Agno Aquino, 42, of Humble, was arrested for his role in a $6.9 million Medicaid fraud and kickback scheme, alongside Rene Gaviola, 67, and Ifeanyi Ndubisi Ozoh, 51, of Houston, who were previously arrested. TDI doesnt regulate doctors, hospitals, Medicaid, or Medicare. There is no cost to you for an External Review. For a larger guide of who regulates what and where to get help in Texas, visit USA.gov. The team will tell you the resolution and any next steps you might need to take. 3750 Monroe Avenue, Suite 705 (7 a.m. to 7 p.m. Central Time, Monday to Friday), TMHP-CSHCN Services Program Client Line8778882350 You, your provider, or your legal authorized representative can ask for an emergency appeal by calling Superiors Medical Management department at 1-877-398-9461. Austin, TX 78741 You can call us to let us know you want to appeal an adverse benefit determination or you can send your request in writing. Texas STAR Frequently Asked Questions | UnitedHealthcare Community Plan you may file a complaint with the Texas Health and Human Services Commission by phone at 1-800-252-8263, . You have the right to appeal Superiors decision if Medicaid covered services that require authorization are denied, reduced, suspended or ended. Is stopping coverage for care you think you/your child needs. Call Member Services at the number on the back of your ID card. Medical and dental checkups and health care for TTY English (800) 735-2989 or dial 711. You will need Adobe Reader to open PDFs on this site. Find out more about our Medicaid Client Service Center. To ensure coverage continues, if you're eligible, report changes (contact information, pregnancy, etc.) The TMHP-CSHCN Services Program Contact Cen ter at 1-800-568-2413 . P.O. HHS How to Submit a Complaint English (PDF), HHS How to Submit a Complaint Spanish (PDF), send it to the addresses listed on the Texas Department of Insurance website, Managed Care Regular Complaint FY 22 Q4 Accessible Tables, Managed Care Regular Complaint FY 22 Q4 Tableau, Managed Care Regular Complaint FY 23 Q1 Accessible Tables, Managed Care Regular Complaint FY 23 Q1 Tableau, Managed Care Initial Contact Complaint FY 22 Q4 Accessible Tables, Managed Care Initial Contact Complaint FY 22 Q4 Tableau, Managed Care Initial Contact Complaint FY 23 Q1 Accessible Tables, Managed Care Initial Contact Complaint FY 23 Q1 Tableau. Before sharing sensitive information, make sure youre on an official government site. nally denied as an "Incomplete Claim" on an R&S Report) Texas Medicaid & Healthcare Partnership Attn: CSHCN Services Program Claims PO Box 200855 Austin, TX 78720-0855 . (7 a.m. to 7 p.m. Central Time, Monday to Friday), Supplemental Security Income (SSI) questions, Social Security Administration8007721213, TMHP Personal Care Services Line8882760702. You can call our toll-free hotline at888-987-1200,Monday through Friday, 8 a.m. to 4:30 p.m. Were here every day of the week, except state holidays. We want to help. Provider Relations. We also cant help with self-funded insurance plans. Communication via email is not as secure as communicating via our secure member portal. However, Hotline tips are incredibly valuable, and we appreciate your efforts to help us stamp out fraud, waste, and abuse. If you suspect Medicaid fraud or abuse, or patient neglect, please report it by visiting the OAG's website. For information about COVID-19, call 2-1-1, Option 1. To check the status of your submission, call Medicaid Helpline Fax: 1-866-683-5369. Mail: Medicaid Fraud Control Unit at the Office of the Attorney General, P.O. You can ask to continue current authorized services when you appeal Superiors Adverse Benefit Determination. It can also describe groups of people services are for, like Older Adults or, if youre looking for health-related help, a need can be the specific illness, like Heart Disease. You can also the name of the organization if you dont know the program, End of Continuous Medicaid Coverage | Texas Health and Human Services, Department of Family and Protective Services, Texas Health and Human Services Commission. We will notify you of the emergency appeal decision within 72 hours, unless your appeal is related to an ongoing emergency or denial of continued hospitalization. You will get a decision no later than 72 hours of us receiving the request. Your name or the name of the person you are calling about. You may call the Member Hotline at any time during the appeal . You can file a complaint about: A doctor, hospital, or provider Your health or drug plan Quality of your care Your dialysis or kidney transplant care Durable medical equipment What's the difference between a complaint and an appeal? However, it is impossible to guarantee that data or information will not be intercepted or misdirected during transfer over a phone line, Internet or network. Centers for Medicare & Medicaid Services (CMS) (federal agency that administers Medicare, the nations largest health insurance program) 800-MEDICARE. Superior HealthPlan follows the Texas Medicaid Vendor . . Copyright 2016-2023. warning: this is a texas health and human services information resources system that contains state and/or u.s. government information. Administrative Appeals (for Medicaid providers), Administrative Reviews (for CSHCN Services Program providers). Download the free version of Adobe Reader. A specialty review is when your provider requests the review be completed by a particular type of specialist. File a Medicaid Fraud Complaint. Phone: 888-303-6162 Email: CentralPRTeam@uhc.com. According to the indictment, Gaviola, the operator of Floss Family Dental Care, together with his managers Ozoh and Aquino, submitted fraudulent claims to Medicaid for pediatric dental services that were not provided or were in some cases performed by unlicensed individuals. By mail: Texas Department of . You will need to contact the provider directly to request a refund. Needs: This column refers to what youre looking for, like Rent Payment Assistance or Food Pantries. If the provider is not enrolled or you do not have coverage for the date(s) of service, you will be responsible for the bill. Providers may use three methods to appeal Medicaid fee-for-service and carve-out service claims to Texas Medicaid & Healthcare Partnership (TMHP): electronic, Automated Inquiry System (AIS), or paper. In the event that TMHP receives an electronic mail or online chat message containing confidential patient data, TMHP will not confirm or include any such information in its response. By mailfind the correct address in the appeals section of the. File a complaint by using our online complaint system: Make a copy of the front of your insurance ID card. Provides a partial approval of a request for a covered service. If youre still having issues with your company after youve talked to them first, you can file a complaint with us and well try to help. Download the free version of Adobe Reader. File a complaint. Interpreter services are provided free of charge, call Member Services for assistance. Sign up to receive our weekly newsletter and get all the latest news and updates, including the most recent episode of AFMC TV, right to your inbox! Log into your account at yourtexasbenefits.com or call 2-1-1 and select, Option 2. If the provider is enrolled and you are covered for the date(s) of service, follow these steps: Client Correspondence You can also request any materials on this website in another format, such as large print, braille, CD or in another language. Social Security Administration. Box 12307, Austin, TX 78711-2307. This consent is not required. Pittsford, NY 14534. Before the hearing, Superior will send you all of the documents to be used at the hearing. Contact CMS | CMS - Centers for Medicare & Medicaid Services If you do not want to receive email responses, please let us know. The investigation was conducted by Sergeant Alfred Paige, Investigative Auditor Daryl Middleton, and Captain Alexander Chancia of the Texas Attorney Generals Medicaid Fraud Control Unit (MFCU), in cooperation with the FBI and the Department of Health and Human Services - Office of Inspector General. Email: MFCU@oag.texas.gov. Make a copy of the bill. OIG Hotline Operations accepts tips and complaints from all sources about potential fraud, waste, abuse, and mismanagement in the U.S. Department of Health and Human Services programs. Medicare contacts - Texas Department of Insurance What is the Medicaid Fraud Control Unit? Health Care Fraud and Abuse | Office of the Attorney General End of Continuous Medicaid Coverage | Texas Health and Human Services You may represent yourself at the State Fair Hearing, or name someone else to be your representative. If you have a complaint/grievance or appeal, please contact our Member Hotline at 1-855-691-6262. Not sure who to call with your question or complaint? Organization. You can also ask for an emergency appeal in writing and send it to Superiors Medical Management department at: Superior HealthPlan The managed care organization (MCO) is required to provide HHSC with operational data necessary to consistently evaluate the EVV system and monitor the impact of improvements made to the EVV system and EVV processes. You can also create an account on the Superior member portal.