Frequently Asked Questions
Who does STAR Health provide services for?
STAR Health provides healthcare and other services for most children and young adults in foster care and kinship care. This may include young adults who choose to remain in a paid foster care placement until the age of 22 as well as children who aged out of foster care at the age of 18. Superior has the exclusive contract to provide STAR Health services in all 254 Texas counties.
What forms does the Medical Consenter need to take to an appointment?
As a STAR Health provider, you can accept three forms of proof that the child is enrolled in the STAR Health Program:
- Your Texas Benefits card: If the caregiver has not received a child's card, the DFPS caseworker should contact the regional Eligibility Specialist for assistance.
- STAR Health ID card: Superior sends out the ID card once it receives information that a child is in DFPS conservatorship, has changed placements or selected a new Primary Care Provider (PCP). Members can request replacement cards by calling STAR Health Member Services at 1-866-912-6283.
- DFPS Form 2085-B, Designation of Medical Consenter: DFPS provides this form to caregivers when the child is placed in their care and updates it when there is a change in who can consent for the child.
If there is a question about the child's eligibility, the caregiver can call STAR Health Member Services at 1-866-912-6283 while still at the provider's office. A representative from STAR Health will speak with the provider to resolve the situation.
What if I have questions about prior authorization?
Some services may require prior authorization. To submit a request, fill out the Service and Procedure Prior Authorization Form and fax it to 1-800-690-7030. You may also call 1-800-218-7508 if you need help with the form or have any questions.
How do I request prior authorization for medications through Envolve Pharmacy Solutaions?
To request prior authorization, submit the request to US Script via the online request form at Pharmacy.EnvolveHealth.com by calling 1-866-399-0928 or to fax 1-866-399-0929.
Do providers have access to Health Passport?
Yes! If you are having issues logging into Health Passport you can call the Health Passport Support Desk 1-866-714-7996 or email TXPassportAdmin@centene.com.
Where can I find STAR Health member rights and responsibilities?
STAR Health Member Rights and Responsibilities may be found on the STAR Health website, by visiting Member Rights and Responsibilities.
How do I file a Medicaid member appeal on behalf of a member?
Medicaid members, a person acting on their behalf with the member’s written consent, or their physician or other healthcare provider may request an appeal of an adverse determination. All STAR Health standard appeal requests must be confirmed in writing and signed by the member or the member’s authorized representative.
Medicaid appeal requests must be received within sixty (60) days from the date of the denial letter. Superior will acknowledge a standard appeal request within five (5) days of receipt. The standard appeal process must be completed within thirty (30) days. Any additional information that may be used in consideration of the appeal must be submitted to Superior.
What is the requirement for Texas Health Step exams for children in foster care?
STAR Health members are subject to the following requirements:
- All children newly enrolled in the STAR Health program need a Texas Health Steps checkup within thirty (30) days of enrollment.
- An annual medical checkup for existing Members age thirty six (36) months and older are due on the child’s birthday.
- New members who are age six (6) months and over must have a dental checkup within sixty (60) days of enrolling in the STAR Health program.
If a member needs additional information or has questions about STAR Health requirements, members can call Member Services at 1-866-912-6283.
What if I have a question about filing a claim?
Superior’s Provider Services staff can help you with filing a claim. They will answer your questions about claim status and payments and assist with appeals. You can call Provider Services from 8 a.m. to 5 p.m. (Central Time), Monday through Friday, at 1-866-439-2042. You can also login to the provider web portal at https://provider.superiorhealthplan.com/sso/login.
WHAT CAN MEMBER SERVICES HELP WITH?
Member Services can make Primary Care Provider (PCP) changes, send you replacement ID cards if lost or stolen and help explain benefits. They can help make appointments for your child. Member Services can also refer you to other staff that can help with community resources. Call 1-866-912-6283 for help.
What are Provider Advisory Groups?
Provider Advisory Groups are a forum for Superior to gather valuable feedback from providers about processes and interactions with Superior departments. Superior asks providers about topics like member services, provider services, service coordination, prior authorization, billing and claims. In addition, Superior provides updates and education about provider resources. Meetings are set quarterly throughout the year. Contact your Account Manager for more information.
Who do I contact with questions about STAR Health?
You can call Provider Services with any questions you may have at 1-800-439-2042
How Can I Replace a Lost or Stolen ID Card?
You should always carry your/your child’s Superior Member ID card with you. You’ll need this for doctor’s appointments or when picking up medications. If you change your name, need to pick a new Primary Care Provider (PCP) or your Superior Member ID card is lost or stolen, please call 1-866-912-6283. You will get a new Superior Member ID card.