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Effective 4/1/26: Authorization Requirements for Medicaid and CHIP Coordination of Benefits Claims

Date: 03/27/26

As a Medicaid and CHIP Managed Care contractor with the Texas Health and Human Services Commission (HHSC), Superior HealthPlan is responsible for coordinating benefits with another payor that is the primary insurer for Superior Medicaid (STAR, STAR Kids and STAR+PLUS) and CHIP members, on behalf of HHSC. Superior is further responsible for establishing plans and processes for avoiding and recovering costs for covered services that should have been paid by a primary payor.

Texas Medicaid and CHIP do not provide reimbursement for covered services or supplies that are not medically necessary, and Superior must provide covered services in the amount, duration and scope established by HHSC. To ensure compliance with these requirements, Superior must confirm that a service is medically necessary and a covered service, whether Texas Medicaid or CHIP is the primary or secondary payor.   

To comply with current regulatory requirements, providers must obtain authorization from Superior when applicable, regardless of whether Superior Medicaid or CHIP is the member’s primary or secondary health care coverage.

Effective for service dates on and after April 1, 2026:

  • If a Superior Medicaid (STAR, STAR Kids or STAR+PLUS) or CHIP member has insurance that is primary to the member’s Superior coverage; and
  • A Medicaid or CHIP secondary payer claim is submitted to Superior for reimbursement of the cost share not covered by the member’s primary insurance; and
  • The service submitted on the claim requires authorization, but no authorization has been requested and approved for coverage of the service, the Superior secondary payor claim will be denied for lack of authorization.

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

If you have any questions regarding this communication, please contact your Superior Provider Representative. To find their contact information please visit the Find My Provider Representative webpage.