Skip to Main Content

Medicaid and CHIP Prior Authorization

DISCLAIMER: Your current browser's security settings does not allow the use of this tool. This tool requires the use of Internet Explorer 10 or Later. If you are currently using Internet Explorer as your browser and you see this message, you should try to update it or use another browser like Google Chrome or Firefox.

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 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.

Musculoskeletal, Ear, Nose and Throat (ENT) Surgeries, Sleep Study Management and Cardiac Surgeries Need to be Verified by TurningPoint.

Non-participating providers must submit prior authorization for all services*
For non-participating providers, Join Our Network

*Please note, Incontinence Supplies ordered through the preferred DME provider do not require prior authorization.

Would this be for Family Planning services billed with a contraceptive management diagnosis OR Is this service for a Star Kids or Star Health Member for school based telemedicine?

Types of Services YES NO
Are services being provided by a non-participating provider?
Is the member being admitted to an inpatient facility?
Is the member receiving oral surgery services?
Is the member receiving plastic and reconstructive surgeon services?

To supplement the Prior Authorization Prescreen Tool, providers may access Prior Authorization Requirements for Medicaid and CHIP Services (PDF), to verify prior authorization requirements for all Medicaid and CHIP services, and confirm the effective date of new prior authorization requirements implemented on or after September 1, 2019.

Clinical Documentation Requirements for Health Care Services that Require Authorization (PDF)
This listing provides the clinical documentation required to be submitted with requests for medical necessity review and approval through Superior’s contracted Utilization Review Agents (URA).

To access prior authorization lists, please visit Superior’s Prior Authorization Requirements webpage.

To access Superior clinical and payment policies, visit Clinical & Payment Polices