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STAR Kids Referrals and Authorizations Frequently Asked Questions

Date: 09/19/16

What is a referral?

Your doctor will talk to you about your/your child’s needs and will help make plans for you to see a specialist. This is called a referral. Your doctor will work closely with your specialist to coordinate services and make sure you are getting the care you/your child needs.

Do I need a referral to see a specialist?

You do not need a referral from Superior to see a specialist. However, some specialists may require a referral from your PCP if you are a new patient. If your child has an existing relationship with a specialist, a referral would not be needed from your PCP.

What is an authorization? When do I need one?

Some services or treatments provided in a specialist’s office may need approval from Superior. This is called an authorization. Contact Superior to find out what requires prior authorization.

What if my child’s specialist is not in Superior’s network?

For twelve (12) months following STAR Kids implementation (November 1, 2016), you can continue to see a Medicaid out-of-network physician specialist with whom you have an existing relationship, including providers outside the service delivery area. Please note that all providers must be Medicaid approved providers and the services provided must be Medicaid covered services. Authorizations for office visits are not required.  Authorizations for services and treatments may still be required. If you/your child receives services from a specialist who is not a Medicaid provider and/or doesn’t accept your primary insurance plan, you might be responsible for the bill.

Superior will work with you and your specialist to ensure you/your child continue to receive care until the specialist joins the Superior network or you/your child are transitioned to an in-network provider.  If you see a specialist who is not a Superior provider or does not accept Medicaid, you may get a bill from your provider.

What if my child needs emergency or urgent services from a specialist?

No referral or authorization is needed for emergent or urgent services as long as the provider is in Superior’s network or accepts Medicaid. If the specialist is not a Superior or Medicaid provider, you may receive a bill. Please note: If emergent or urgent services were provided in an office setting, your provider should contact Superior as soon as possible after the visit as some services require an authorization.

My child is already has a specialist or PCP and we have Medicare/private insurance. Can we continue to see them?

Yes. If your child has Medicare or private insurance you do not need a referral or authorization from Superior. Your child can continue to see their PCP or specialists as long as they are accepted by your private insurance or Medicare plan. If your provider leaves the network, Superior can help you find a new one.