Network Request or Update
Non-contracted Medical, Behavioral Health and Specialty Providers
Superior HealthPlan serves members in all 254 counties across Texas. Non-contracted providers may use this form to express interest in joining the Superior network. We are currently accepting inquiries for network participation for PCPs and many specialties. Please complete the Network Participation Form and allow up to 30 days for evaluation and response of your inquiry.
Please note: Wraparound training is a requirement for Mental Health (MH) Targeted Case Management (TCM) providers to provide intensive targeted case management. Review the Wraparound Training for MH TCM/Rehab Providers.
Checklist of documents required to complete credentialing:
- Complete the Individual and Group Provider Credentialing Application
- Copy of Professional License
- Copy of Certificate of Professional Liability Insurance
- Disclosure of Ownership and Control Interest Statement
- Copy of DEA Certificate, if appliable
- Collaborating Physician Form, if applicable
- Supervising Physician Form, if applicable
- Copy of Clinical Laboratory Improvement Amendments (CLIA), if applicable
- Accreditation/Site Visit/Rural County/CMS Letter, if applicable
- Central Registry Check Request for Abuse/Neglect - Form 1600, for behavioral health foster care providers only
For questions on the credentialing process, please:
- Email: SHP.NetworkDevelopment@SuperiorHealthPlan.com
- Call: Superior Provider Services at 1-877-391-5921
Non-contracted Vision, Dental and Pharmacy Providers
Contracted Medical or Ancillary Providers
Contracted providers can use this form to add a product, provider or location to an existing contract. Please note, if you are affiliated with a third party Delegate Manager, all changes must be made at the request of the Delegate. Contact your Delegate Manager for additional information.
NOTE: The following requests should be submitted by contacting your Account Management Representative.
- Medical Providers and Groups (MD, DO, DC, DPM and Physician Extenders) who want to add a new practice location and are currently credentialed by Superior; or
- Ancillary providers who want to add a new practice location that will operate under the same state license and TIN/NPI combination.
Request Type [select one]:
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