Evidence record
Dental Value-Added Services—Superior HealthPlan, Inc.
- Jurisdiction
- Texas
- Publication date
- February 20, 2026
- Source record
- Original document linked
Findings
2
Recommendations
5
Overall conclusion
Superior HealthPlan, Inc. did not consistently submit dental value-added services encounters with the correct financial arrangement code.
Scope
The inspection scope covered the period from September 1, 2022, through August 31, 2023.
Findings (2)
Each finding has a stable link.
- F-1140
Superior used the incorrect financial arrangement code on 1,635 of 16,180 (10 percent) STAR+PLUS dental value-added services encounters; these were coded as payable dental services (financial arrangement code 04) instead of value-added services (financial arrangement code 11), totaling $58,823.
- F-1141
The incorrect encounters may have been carried through to Superior’s Financial Statistical Reports (FSRs) and could affect capitation rates and potential experience rebates.
Recommendations (5)
- R-1002
Implement controls to verify it reports STAR+PLUS dental value-added services encounters with the correct financial arrangement code.
Related finding F-1140 - R-1003
Correct the encounters and paid claims submitted with the incorrect financial arrangement code as applicable.
Related finding F-1140 - R-1004
Review its state fiscal year 2023, 2024, and 2025 FSRs to determine whether any reported dental value-added services expenses were included in the medical expenses.
Related finding F-1141 - R-1005
Contact HHSC Financial Reporting and Audit Coordination to receive guidance on the correction of any misreported medical expenses.
Related finding F-1141 - R-1006
Review its state fiscal year 2026 encounters to verify financial arrangement code 11 was used as applicable until a control is implemented.
Related finding F-1140