Behavioral Health
The following Behavioral Health Credentialing forms can be found on Superior's Provider Forms webpage, under the Credentialing section.
- Behavioral Health Disclosure of Ownership and Control Interest Statement
- Behavioral Health Provider Specialty Profile
- Central Registry Check Request for Abuse/Neglect - Form 1600 (for Foster Care providers)
Teledoc is a free online tool available to Superior members and providers. This tool offers digital behavioral health solutions to help empower individuals with engaging, clinically-proven resources.
Teledoc partners with over 140 of the largest healthcare payers and providers in the US, to extend evidence-based behavioral health access to covered members, promoting higher levels of engagement and satisfaction, improved outcomes and reduced cost of care delivery.
For more information, please visit the Teledoc website.
Access the Discharge Medication Referral Form (PDF), under Medicaid Prior Authorization Forms, on Superior’s Provider Forms webpage.
Ambetter
- Inpatient Ambetter Authorization Fax Form (PDF)
- Outpatient Prior Authorization Fax Form (PDF)
- Ambetter Inpatient Electroconvulsive Therapy (ECT) Request Form (PDF)
- Ambetter Outpatient Electroconvulsive Therapy (ECT) Request Form (PDF)
- Ambetter Outpatient Treatment Request Form (PDF)·
- Ambetter Psych or Neuropsych Testing Inpatient Request Form (PDF)
Medicaid
- Inpatient Medicaid Authorization Form (PDF)
- Outpatient Medicaid Authorization Form (PDF)
- Medicaid Discharge Consultation Form (PDF)
- Medicaid Inpatient Electroconvulsive Therapy (ECT) Request Form (PDF)
- Medicaid Outpatient Electroconvulsive Therapy (ECT) Request Form (PDF)
- Medicaid Outpatient Neuropsychology and Psychological Testing (PDF)
- Medicaid Outpatient Treatment Request Form (PDF)
- Texas Standard Prior Authorization Request Form for Health Care Services (PDF)
Medicare
- Inpatient Medicare Authorization Fax Form (PDF)
- Outpatient Medicare Authorization Fax Form (PDF)
- Medicare Inpatient Electroconvulsive Therapy (ECT) Request Form (PDF)
- Medicare Outpatient Electroconvulsive Therapy (ECT) Request Form (PDF)
- Medicare Outpatient Treatment Request Form (PDF)
- Allwell Change of Provider Request Form (PDF)
- Ambetter Change of Provider Request Form (PDF)
- Change of Provider Request Form (PDF)
- Cognitive Behavior Therapy (CBT) and Eye Movement Desensitization and Reprocessing (EMDR) Provider Directory (Excel)
- HHSC Peer Support Services
- Implementing the Child Psychiatry Access Network (CPAN) for Pediatricians (PDF)
- MMP Change of Provider Request Form (PDF)
- Senate Bill 58 Service Provider Credentialing & Ongoing Service Delivery Process (PDF)
- STAR Health Trauma-Informed Care Alternative Payment Model
- Trauma Informed Care MD
Behavioral Health Toolkit
Relevant Research
- ADHD Reference Guide (PDF)
- Evaluation and Treatment of ADHD (PDF)
- Adopted Clinical Practice Guidelines
Screening Tools
NICHQ Vanderbilt Assessment Scales (PDF)
Resources for Patients
- Center for Disease Control and Prevention- ADHD Treatments Recommendations
- Evaluating your Child for ADHD (PDF)
- Superior HealthPlan Member Wellness Plan - English (PDF)
- Superior HealthPlan Member Wellness Plan - Spanish (PDF)
Related Information
Relevant Research
Centers for Disease Control and Prevention (CDC): Alcohol and Public Health Resources
Screening Tools
Resources for Patients
- CDC Fact Sheets: Alcohol Use and Your Health
- CDC Fact Sheets: Binge Drinking
- National Institute of Alcohol Abuse and Alcoholism (NIAAA): Alcohol and Your Health
- NIAAA - Binge Drinking
- NIAAA: Mixing Alcohol with Medicines
- NIAAA Brochure: Fetal Alcohol Syndrome (PDF)
- NIAAA Brochure: Talk to Your Child About Alcohol
Related Information:
Relevant Research
- Anxiety Disorders in Primary Care (PDF)
- American Family Physician (AFP): Anxiety Disorders
- National Institue of Mental Health: Anxiety Disorders
- National Istitue of Mental Health: Obsessive-Compulsive Disorder
Screening Tools
- Generalized Anxiety (GAD-7), Social Anxiety (SPIN), Panic Disorder (PHQ)
- Posttraumatic Stress Disorder (PC-PTSD-5) (PDF)
- Obsessive Compulsive Disorder (Y-BOCS) (PDF)
Resources for Patients
- US Department of Veterans Affairs: National Center for PTSD
- Superior HealthPlan Member Wellness Plan - English (PDF)
- Superior HealthPlan Member Wellness Plan - Spanish (PDF)
Related Information:
Relevant Research
- Adopted Clinical Practice Guidelines
- The Role of Primary Care Clinicians in Diagnosing and Treating Bipolar Disorder
- The Diagnosis and Treatment of Bipolar Disorder: Decision-Making in Primary Care
- National Istitue of Mental Health: Bipolar Disorder
Screening Tools
- The Mood Disorder Questionnaire (MDQ) (PDF)
- Composite International Diagnostic Interview (CIDI) Bipolar Disorder Screening Scale (PDF)
Resources for Patients
- Depression and Bipolar Support Alliance- Find Support
- Depression and Bipolar Support Alliance- Bipolar Disorder
- International Bipolar Foundation
- Juvenile Bipolar Research Foundation
- Family Support: Bipolar Care Givers
- Superior HealthPlan Member Wellness Plan - English (PDF)
- Superior HealthPlan Member Wellness Plan - Spanish (PDF)
Related Information:
Relevant Research
Screening Tools
- Edinburgh Postnatal Depression Scale (EPDS) (PDF)
- Patient Health Questionnaire Screeners: Patient Health Questionnaire (PHQ) 9
Resources for Patients
- National Institute of Mental Health (NIH): Publications about Depressions
- Anxiety and Depression Association of America
- Helpguide: Coping with Depression
- Superior HealthPlan Member Wellness Plan - English (PDF)
- Superior HealthPlan Member Wellness Plan - Spanish (PDF)
Related Information:
Relevant Research
Vanderbilt Kennedy Center - PCP Toolkit for Adults with Intellectual and Developmental Disabilities
Resources for Patients
- The Arc: For People with Intellectual and Developmental Disabilities
- American Association on Intellectual and Developmental Disabilities
Related Information:
Relevant Research
- JAMA Network: Anticholinergic Drug Exposure and the Risk of Dementia (55 and Older)
- Texas Health and Human Services (HHS): Psychotropic Medication Utilization Parameters for Children and Youth in Texas Public Behavioral Health (6th Version) (PDF)
Screening Tools
- Abnormal Involuntary Movement Scale (AIMS) (PDF)
- Anticholinergic Burden Calculator (ACB)
- Pediatric Antipsychotic Metabolic Monitoring Form (PDF)
- PMUR Pocket Resource Guide (PDF)
Related Information
Relevant Research
Resources for Patients
- Brochures: Schizophrenia
- Superior HealthPlan Member Wellness Plan - English (PDF)
- Superior HealthPlan Member Wellness Plan - Spanish (PDF)
Related Information:
Relevant Research
Resources for Patients
Related Information:
Relevant Research
- Department of Veterans Affairs and the Department of Defense (VA/DOD) Clinical Practice Guideline for the Management of PTSD and Acute Stress Disorde (PDF)
- American Academy of Pediatrics (AAP): Trauma Guides for Pediatricians and Primary Care Providers
- SAMHSA’s TIP 57: A Treatment Improvement Protocol for Trauma-Informed Care in Behavioral Health Services (PDF)
- National Institutes of Health (NIH): Trauma Exposure in Anxious Primary Care Patients (PDF)
- From Treatment to Healing: The Promise of Trauma-Informed Primary Care (PDF)
Screening Tools
- National Center for PTSD: Assessment Overview and Resources
- The Children’s Impact of Event Scale (CRIES-13) (PDF)
Resources for Patients
- American Academy of Child & Adolescent Psychiatry: Trauma and Child Abuse Resource Center
- American Academy of Pediatrics: Trauma-Informed Care Clinical Report
- The National Child Traumatic Stress Network
- US Department of Veterans Affairs: National Center for PTSD
- National Institute of Mental Health: Publications about Coping with Traumatic Events
- Superior HealthPlan Member Wellness Plan - English (PDF)
- Superior HealthPlan Member Wellness Plan - Spanish (PDF)
Related Information:
Relevant Research
- National Institute of Alcohol Abuse and Alcoholism (NIAAA): Commonly Abused Drugs Charts
- NIAAA: The Science of Drug Abuse and Addiction: The Basics
- Screening, Brief Intervention, and Referral to Treatment (SBIRT): A Resource Toolkit for Behavioral Health Providers to Begin the Conversation with Federally Qualified Healthcare Centers (PDF)
- Substance Abuse and Mental Health Services Administration (SAMHSA): Age-and Gender-Based Populations