Network Status Inquiry Form

Superior HealthPlan offers dedicated Provider Representatives across Texas to support provider network needs. This form allows providers to submit inquiries regarding contract status, initial credentialing, or network participation. Submissions are routed to the Provider Engagement Network Specialists (PENS) via a central inbox, helping streamline the process and ensuring requests are handled efficiently and responses are provided accurately and promptly.

Group & Individual Provider Information

Fields marked with an asterisk (*) are required fields.

Clinic/Facility Name (Group): *

Group Tax ID Number (TIN): *

Group National Provider Identifier (NPI) or Atypical Provider Identifier (API): *

Individual Practitioner/Clinician Name: *

Individual Practitioner/Clinician NPI or API: *

Who should we contact?

Primary Contact Name: *

Primary Contact Phone: *

Primary Contact Email Address: *

How may we assist? * Contracting and Initial Credentialing Status Recredentialing Status

Provider Contract and Initial Credentialing Status Inquiry Form

This form may only be completed if requesting contracting or initial credentialing status. If you are inquiring about status of recredentialing, please go back and select the “Recredentialing” option above.

Date the initial contract request form was submitted: * Format: MM/DD/YYYY

Please tell us how we can help? *

Provider Re-Credentialing Status Inquiry Form

This form may only be completed if requesting recredentialing status. If checking contracting or initial credentialing status, please go back and select the “Contracting/Initial Credentialing” option above.

Date the initial contract request form was submitted: * Format: MM/DD/YYYY

Please tell us how we can help? *