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The help line is open Monday to Friday, 8 AM to 5 PM CT. By fax: 512-475-1771 Online: Just visit the Texas Department of Insurance to get help with an insurance complaint. The defendants are charged with defrauding the Medicaid program through illicit practices committed through the Floss Family Dental Care clinic in Houston. Medicaid and the Children's Health Insurance Program (CHIP) are joint federal/state programs for which state Medicaid/CHIP agencies have full . Within five (5) Business Days, Superior will give the examiner all documents and information used to make the internal appeal decision. ATTN: Medical Management HHS will make the PDL changes based on recommendations made at the January and April 2023 Texas Drug Utilization Review Board meetings. For more information about TMHP website Terms and Conditions of use, click here: Contact Us | Texas Medicaid | Superior HealthPlan We recommend you review Before You Submit a Complaint to understand the type of complaints we do and do not investigate and the complaint process. Official websites use .gov Superior will acknowledge your appeal within five (5) Business Days of receipt, and complete the appeal within 30 calendar days. You can ask for a State Fair Hearing without an External Medical Review. MAXIMUS will also send a written version of the decision within 48 hours of the phone call. The defendants are also accused of offering illegal kickbacks to marketers and caregivers of Medicaid-insured children, enticing them to bring the children to Floss for fraudulent dental services. If you, as a member of Superior, disagree with our internal appeal decision, you have the right to ask for an External Medical Review. File a complaint by using our online complaint system: Make a copy of the front of your insurance ID card. To check the status of your submission, call Medicaid Helpline Expedited complaints concerning emergencies or denial of continued hospitalization will be resolved within one business day from receipt of the complaint or earlier depending on the medical immediacy of the case. You must complete the internal health plan appeal process through Superior HealthPlan prior to requesting a State Fair Hearing. (All reports are in PDF format.). Austin, TX 78720-2018. Texas Medicaid renewals are coming back. We will work on your problem until we find you an answer. To remain truly anonymous, you are encouraged to make the report online through ReportTexasFraud.com. 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. You can also create an account on the Superior member portal. Find out more about our Medicaid Client Service Center. Other important information, such as birthdays or home addresses. Download the free version of Adobe Reader. Austin, TX 78741 Include your adverse benefit determination letter from Superior when mailing or faxing your request to MAXIMUS. Doctors: Texas Medical Board 800-248-4062 File a complaint, Hospitals and nursing homes: Texas Health and Human Services 512-424-6500 File a complaint, Medicaid and CHIP: Texas Health and Human Services Medicaid: 800-252-8263 CHIP: 877-543-7669 File a complaint, Medicare (doctors, hospitals, plans, quality of care, medical equipment): Medicare.gov 800-633-4227 File a complaint. A Member Advocate will help you. Send written complaints to: UnitedHealthcare Dental Texas Children's Medicaid Appeals/Complaints Department P.O. State Auditor's Office Hotline: 800-TX-AUDIT. Texas Health and Human Services (HHS) will perform the semi-annual update of the Texas Medicaid preferred drug list (PDL) on July 27, 2023. (7 a.m. to 7 p.m. Central Time, Monday to Friday), Questions about CSHCN Services Program benefits. A complaint acknowledgement letter will be sent to you within five (5) days. 5900 E. Ben White Blvd., The MFCU receives 75 percent of its funding from the U.S. Department of Health and Human Services under a grant award totaling $20,944,200 for fiscal year (FY) 2023. Interpreter services are provided free of charge, call Member Services for assistance. For instructions on filing a tip on a CLASSIFIED matter, call 1-800-447-8477. Superior will make a decision about your expedited appeal within one (1) Business Day, and send you a letter within 72 hours. The MCO is required to document EVV metrics on the EVV MCO Quarterly Performance Measures Report Instructions and Template (UMCM 8.7.2). Provider Relations. Have any documents related to your complaint, such as letters, bills or prescriptions, ready too. If you continue with the State Fair Hearing, you can also request the Independent Review Organization be present at the State Fair Hearing. This consent is not required. You can also complain to the Texas Health and Human Services Commission (HHSC) by emailing. You will be notified of the appeal decision within one (1) business day for denials of on-going emergency or denial of continued hospital stay. An expedited appeal is when Superior HealthPlan has to make a decision quickly based on the condition of your health, and taking the time for a standard appeal could jeopardize your life or health. . people who are 20 or younger. You can call or request in writing to let us know you want to appeal an Adverse Benefit Determination. You have the right to examine, at a reasonable time before the date of the Fair Hearing, the contents of your case file and any documents to be used by Superior at the hearing. TMHP is unable to assist with refund requests for any monies that you have paid to a provider. You, your provider or another person acting on your behalf can file an appeal. CMS Regional Offices CMS Baltimore Headquarters Telephone Numbers Toll-Free: 877-267-2323 (Employee directory available) Local: 410-786-3000 TTY Toll-Free: 866-226-1819 We use this information to make sure we know who you are and the details of your case are secure. In Texas, Medicaid costs taxpayers over $40 billion. Complaints may be made by calling Superior Member Services at the number on the back of your ID card (Relay Texas 1-800-735-2989). Medicaid Helplines8003358957 and 8002528263 Call or write us! Log into your account at yourtexasbenefits.com or call 2-1-1 and select, Option 2. Austin headquarters The indictment also details how Gaviola laundered Medicaid funds, transferring them from the Floss business bank account to his personal account in transactions exceeding $100,000. The site is secure. Call the OIG Fraud Hotline if you suspect wrongdoing - Texas You or someone acting for you will receive the decision by phone. The email is not encrypted and is not transmitted in a secured format. Note: TDI regulates Medicare supplement insurance and can help with questions or complaints. Send your request for External Review directly to MAXIMUS at: MAXIMUS Federal Services During the hearing, you or your representative can tell why you need the service or why you disagree with the Superiors action. Call the MCNA Member Hotline at 1-855-691-6262 to ask a Member Advocate for help filing an appeal. 5900 E. Ben White Blvd. 800-633-4227. File a complaint. CHIP: 877-543-7669. Log into your account at yourtexasbenefits.com or call 2-1-1 and select, Option 2. On January 1, 2021, HHSC required Electronic Visit Verification (EVV) for all Medicaid personal care services as mandated by the federal 21st Century Cures Act. Texas Relay Spanish (800) 662-4954. or. Box 1427 Milwaukee, WI 53201 Can someone from UnitedHealthcare Dental help me file a complaint? You will need to contact the provider directly to request a refund. To submit a complaint to the HHS Ombudsman, you can: The Ombudsman's team will get back to you within one business day. You can call us to let us know you want to appeal an adverse benefit determination or you can send your request in writing. 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. The State Fair Hearing officer will provide a response on your expedited State Fair Hearing request within three (3) business days. Austin, TX 78741 Request assistance from TMHP by forwarding the bill(s) to the Client Correspondence Unit. HHSC may need to send you a notice that your . If you don't have a health or dental plan, call the Medicaid helpline at 800-335-8957. To help resolve your complaint, we need to share your information with the . Breadcrumb Home Client/Cliente Contact Important Telephone Numbers Last updated on 11/24/2020 You may submit an Administrative Review within 30 days of the date of the denied authorization. Texas Health & Human Services Commission. How to file a health insurance complaint - Texas Department of Insurance Your name or the name of the person you are calling about. 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. A .gov website belongs to an official government organization in the United States. Note: TDI regulates Medicare supplement insurance and can help with questions or complaints. To file your complaint, send to: Superior HealthPlan Check out the topics below for more help on where to go if you have an issue we cant help with. Not sure who to call with your question or complaint? We can help. Finding services in your area such as child care. Communication via email is not as secure as communicating via our secure member portal. To request an External Review, you must provide the following information: name, address, phone number, email address, whether the request is expedited or standard, a completed Appointment of Representative Form (if someone is filing on your behalf) and a brief summary of the reason you disagree with Superiors decision. To qualify for an emergency State Fair Hearing through HHS, you must have completed Superiors internal appeals process. Go to our online complaint system. Every report we receive is important, however, not every submission results in an investigation. Administrative Appeals (for Medicaid providers), Administrative Reviews (for CSHCN Services Program providers). But heres where you can go for questions or complaints about: Body shops: Texas Attorney General 800-621-0508 File a complaint, Tow truck companies: Texas Department of Licensing and Regulation 800-803-9202 File a complaint. 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. The new categories were not included in the original complaint data; therefore, an updated report, incorporating this change, is being posted. HHS will give you a final decision within 90 days from the date you asked for the State Fair Hearing. Austin, Texas 78741 Pittsford, NY 14534. (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. What You Need to Know HHS-OIG's Hotline reviews and investigates thousands of complaints each year. By communicating with Superior HealthPlan via email, you give consent to receive information from Superior, which may contain PHI, to your email address. Make a copy of the bill. Mail it to:Medicaid Client Relations SpecialistAFMC1020 West 4thStreet, Suite 300Little Rock, AR 72201. A Superior Member Advocate can help you with any questions you have about filing an appeal. Provides a partial approval for a covered service. Important: You cannot file claims, appeals nor administrative reviews through the complaint process. as soon as possible. P.O. You, your provider, a friend, a relative, lawyer or another spokesperson can request an appeal and complete the appeal form on your behalf. If you are unhappy with Superior, you may file a complaint (PDF). Please complete the captcha by selecting the checkbox, I am not a robot. If you have a health or dental plan, call your health or dental plan first. To file your complaint, you can call Molina Healthcare Member Services at: (866) 449-6849. Tennessee, Texas, Utah, Vermont, Virgin Islands, Virginia, Washington, Washington D.C., West Virginia, Wisconsin, Wyoming . Texas Attorney General's Medicaid Fraud Control Unit Helps Take Down $6 Secure .gov websites use HTTPS For every dollar of state funding, the OAG's MFCU recovers more than 33 dollars for taxpayers. In response to your complaint appeal, a complaint appeal panel including Superior staff, provider(s) and member(s) will be held at a location in your area, upon request. The team will tell you the resolution and any next steps you might need to take. If you have additional questions about provider enrollment, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413. You can file claims on paper or electronically. Before the hearing, Superior will send you all of the documents to be used at the hearing. To view data reports on Medicaid managed care complaint data, see the links below. To ask for an External Medical Review, you or your representative may either: If you ask for an External Medical Review within 10 days from the time you get the appeal decision from Superior, you have the right to keep getting any service Superior denied, based on previously authorized services, at least until the final State Fair Hearing decision is made. Members can get oral interpretation services and information in other formats, like Braille, audio, or large print free of charge. If you do not agree with Superiors decision to extend the timeframe for the decision on your appeal, you can file a complaint.

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