Effective 10/31/24: Behavioral Health - Substance Use Disorder Treatment Criteria

Date: 07/30/24

Superior HealthPlan STAR+PLUS Medicare-Medicaid Plan (MMP) and Wellcare By Allwell will adopt Change Healthcare’s InterQual ASAM Criteria^® Navigator as the medical necessity review criteria for Substance Use Disorder Treatment for members effective October 31, 2024. Superior ensures medical necessity review criteria is current and appropriate for members and the scope of services provided.

Service/Procedures	Applicable Products	Criteria
Substance Use Disorder Treatment	STAR+PLUS MMP, Wellcare By Allwell	Change Healthcare’s InterQual ASAM Criteria® Navigator, proprietary, but available upon request.

To review prior authorization requirements, please visit Superior’s Prior Authorization webpage.

For questions or additional information, contact the Prior Authorization department at 1-844-744-5315.