Effective 08/31/26: Criteria Change for Elective Deliveries Before 39 Weeks Gestational Age

Date: 07/22/26

Effective August 31, 2026, Superior HealthPlan will utilize different medical necessity review criteria due to clinical policy retirement for Elective Deliveries Before 39 Weeks Gestational Age for Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), CHIP.

Superior ensures medical necessity review criteria are current and appropriate for members and the scope of services provided.

Applicable Products: Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), CHIP

Description	Criteria
Elective Deliveries Before 39 Weeks Gestational Age	Medicaid: Texas Medicaid Provider Procedures Manual CHIP: Change Healthcare’s InterQual criteria, proprietary, but available upon request.

To review prior authorization requirements, please visit Superior’s Prior Authorization webpage.

For questions or additional information, contact Superior’s Prior Authorization department at 1-800-218-7508.