Medicaid and CHIP Prior Authorization
DISCLAIMER: All attempts are made to provide the most current information on the Pre-Auth Needed Tool. However, this does NOT guarantee payment. Payment of claims is dependent on eligibility, covered benefits, provider contracts, correct coding and billing practices. For specific details, please refer to the Superior HealthPlan STAR, CHIP, STAR+PLUS, STAR Health and STAR Kids Provider Manual. If you are uncertain that prior authorization is needed, please submit a request for an accurate response.
Dental services need to be verified by DentaQuest.
Ear, Nose and Throat (ENT) Surgeries need to be verified by TurningPoint.
Musculoskeletal (MSK) Surgical Procedures, Genetic Testing, Imaging, Interventional Pain Management and Cardiovascular Procedures need to be verified by Evolent.
The following services need to be verified by Evolent: Medical Oncology, Radiation Oncology, Dose Optimization, Pediatric Oncology, and Cardiology.
Prior Authorization at a Glance
Prior Authorization is NOT Required
The following services do NOT require prior authorization:
- Services rendered in an emergency room or urgent care center
- Services rendered by a public health or welfare agency
- Family planning services billed with a contraceptive management diagnosis
Prior Authorization IS Required
The following services REQUIRE prior authorization:
- Services rendered by an out out-of-network provider, with the exception of emergency and urgent care services
- Admission of a member to an inpatient facility
- Hospice services
- Anesthesia services for pain management or dental procedures.
- Services rendered at home, other than DME, orthotics, prosthetics, supplies and therapeutic injections
- Services rendered by a chiropractor
Prior Authorization Check
To submit a prior authorization Login Here
To access prior authorization lists, please visit Superior’s Prior Authorization Requirements webpage.
To access Superior clinical and payment policies, visit Clinical & Payment Polices.