SHP Service Products
This product, known as the State of Texas Access Reform, offers Medicaid services to members.
What is STAR?
This form is used for all professional services, non-hospital outpatient clinics, ancillary services, and DMEs.
What is a CMS 1500? (HCFA)
This system should be used to research an authorization number.
What is TruCare?
This is our interest rate (percentage) mandated by the state of Texas.
What is 18%?
This system is used for running claims reports.
What is Golden?
This health insurance is designed for children in Texas without health insurance who may be able to get low cost or free health coverage.
What is CHIP?
This form is for Inpatient/Outpatient hospital charges, nursing home services, and home health.
What is a CMS 1450 (UB-04)?
These are 10 digit alphanumeric character sets used to classify health care organizations in accordance to the primary services they provide.
What are taxonomy codes?
This system is used to review, pend, and/or hold claims ready for checkrun.
What is PPS (Provider Payment Systems)?
This team created an Inquiry for CR projects.
Who is the CIA Team?
This is a managed healthcare program that provides Medicaid benefits to most children and youth in the Texas Department of Family and Protective Services (DFPS) conservatorship.
What is STAR Health?
This is known as the 4th step of adjudication.
What is Authorization?
This EX code is applied to communicate to the provider that the adjustment request has been processed on a different claim number.
This system is used to review configuration tickets.
What is ServiceNow?
Per TMHP/HHSC, SHP has this many days from posting Fee Schedule rate updates to have the processing system updated and claims finalized.
What is 60 business days?
This Texas Medicaid managed care program is designed to provide healthcare, acute and long-term services, and support for individuals 21 and older and receive SSI.
What is STAR+Plus?
This screen is Amisys is used to search for claims by a member's ID number.
What is the IQ1300?
Every payclass will have service qualifiers tied to the pay service. You can verify in Amisys by looking at this screen.
What is the PC0200 screen?
This system houses all of our Policies and Procedures.
What is Archer?
This type of project is identified when the net payment will result less than the original payment on the claim.
What is a Recoupment Project?
Superior's commercial solution which was provisions as part of the Affordable Care Act.
What is Ambetter/Marketplace?
This pend code is systematically applied to a claim when a provider affiliation cannot be found to apply.
What is EXNQ?
This department manages and maintains all provider demographics, payclass, and billing data.
Who is Provider Data Management?
This turn around time is required for CLs to respond to tasks as well as complaints.
What is 24 hours?
This is the year that Centene Corporation was established.
What is 1984?