Network Request or Update
Non-contracted Medical 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.
Non-contracted Behavioral, Vision, Dental and Pharmacy Providers
- Please visit the following websites to request enrollment for these services:
Cenpatico Behavioral Health: http://www.cenpatico.com/providers/provider-application-request
- Envolve Vision Services: http://visionbenefits.envolvehealth.com/provlanding.htm
- DentaQuest: http://www.dentaquest.com/tx/
- MCNA Dental: http://www.mcna.net/en/providers-overview
- CVS/Caremark: www.caremark.com/pharminfo
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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