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Provider Representative Contact Form

Superior HealthPlan offers dedicated Provider Representatives located in field offices across Texas. You can locate your Provider Representative using the Find My Provider Representative Tool. This form will help streamline the process for providers to submit specific inquiries, which will be handled by the Provider Engagement Network Specialists (PENS). Forms are completed online and routed to a central inbox to ensure your request is processed efficiently and our team can respond accurately and promptly. 

Group & Individual Provider Information

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

Who should we contact?

How may we assist? required *

Find My Provider Representative

Superior offers a self-service tool to assist with locating your assigned Provider Representative. To find your Provider Representative, please visit the Find My Provider Representative Tool and enter your county in the search box. The county entered should be the physical office location. If you wish to contact a Provider Representative instead of using the self-service tool, please continue with the form below.  

Contract Termination Request

The provider termination date must comply with the terms of the provider participation agreement or contract with Superior HealthPlan. Please check your contract terms before submitting a termination request. 

MM/DD/YYYY
Practitioner Individual required *
Clinic/Facility (Group) required *
Product Specific (select all that apply) required *

If the provider is a Primary Care Physican (PCP), please indicate if members will need to be moved to a new PCP and provide the new PCP information.

Member move required required *

Please provide information for the members’ new PCP: 

Demographic Update

All demographic updates for delegated providers must be routed through the delegate through a Provider Adds Changes and Terminations (PACT) form for submission to Superior.

All non-delegated providers may update demographic information via Superior’s Secure Provider Portal. For instructions, please review the Update Provider Demographic Information training guide (PDF). The self-service option through the portal is not available to delegated providers and Provider Representative are not able to assist with demographic changes.

If you have questions or are a non-delegated provider who wants to contact a Superior Provider Representative, please use the Find My Provider Representative Tool or fill out the form below.

Demographic Updates required *

Changes to financial address require submission of an updated W9. Once this form is submitted, a representative will contact you with additional instructions.  

Claim Project Status Request

Are you inquiring about adjudication status of individual claims? required *
Do you have the project reference number? required *

This form may not be used to request individual claim status and is to be used only to check status of projects submitted toreprocess claims.  

Superior offers several self-service options for checking individual claim status through Superior’s Secure Provider Portal, the Availity Essentials portal or by contacting Provider Services at:

STAR, STAR+PLUS, STAR+PLUS MMP, STAR Kids, STAR Health & CHIP: 1-877-391-5921 

Ambetter by Superior: 1-877-687-1196 

Wellcare by Allwell (HMO): 1-800-977-7522 

Wellcare by Allwell (HMO SNP): 1-877-935-8023 

To use this form, the project reference number must be entered. If you do not know the project reference number, please contact your Provider Representative for assistance.  

Negative Balance Request

If you would like to request a Negative Balance Report, please fill out the form below.

Explanation of Payment Request

If you would like to request an Explanation of Payment, please fill out the form below.