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Prior Authorization Requirements

Superior HealthPlan is responsible for ensuring the medical necessity and appropriateness of all health-care services for enrolled members. For some services, clinical review and prior authorization approval is required before the service is delivered.

A listing of the Medicaid, CHIP and Medicare services that require prior authorization may be accessed by visiting:

CHIP pre-authorization approval and denial rates for the medical care or health-care services may be accessed by visiting:

To access Prior Authorization Request forms for applicable services, visit Superior’s Provider Forms webpage.

In addition, an electronic tool is available on Superior’s website that provides procedure code specific information for the services, supplies, equipment and Clinician Administered Drugs (CAD) that require prior authorization. To view the Superior Prior Authorization Prescreen Tool, access the links below by program:

Medicaid and CHIP

For Ambetter, Medicare and STAR+PLUS MMP Prior Authorization Prescreen Tools, please visit:

Ambetter | Medicare Advantage | STAR+PLUS MMP

Please reference the sections below for additional prior authorization requirements and information.

Prior Authorization News