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Provider Credentialing Information and Rights

Date: 05/20/24

Superior HealthPlan's Credentialing Department utilizes a comprehensive process to evaluate and select providers who will serve our members. Each provider must meet minimum qualifications established by Superior and outlined by the National Committee for Quality Assurance (NCQA), State licensing agencies and the Texas Department of Insurance (TDI).

During the credentialing and re-credentialing process, Superior will obtain information from various sources to evaluate applications. Providers/practitioners have the right to review any primary source information that Superior collects during this process such as the National Practitioner Data Bank (NPDB), licensing boards and board certification. However, this does not include the release of references, recommendations or other information that is peer-review protected.

Once a credentialing application is submitted, Superior’s Credentialing Department may contact the provider/practitioner (or designated contact who completed the application) by phone, email and/or by mail to inform them of any information obtained from an outside primary source that varies from the information provided by the practitioner. A response from the practitioner will be requested at this time. The provider/practitioner has the right to correct any erroneous information submitted by another party if the information is:

  • Used in the credentialing/recredentialing process incorrectly.
  • Gathered as part of the primary source verification process and differs from what they submitted on an application.

How to Release Information

To release this information, a written request must be submitted to Superior’s Credentialing Department at the address or email address listed below:

Submitting Corrections

Upon receipt of this information, the provider/practitioner will have 14 calendar days to provide a written explanation to Superior detailing the error or the difference in information. Written explanations may be submitted using the address or email address listed in this notice.

Superior’s Medical Director or Credentialing Committee will then include this information as part of the credentialing/recredentialing process.

Checking Status

Providers/practitioners have the right to be informed of the status of their credentialing/recredentialing application upon written or verbal request to Superior’s Credentialing Department.

  • Written requests may be submitted at the address or email address listed in this notice.
    • Please include practitioner or provider’s name, NPI, and Tax ID. 
  • Verbal requests may be submitted by phone at: 1-800-820-5686.
    • Phone inquiries will receive a response via email or phone within 14 days of receipt.

For questions, requests or more information, please contact Superior’s Credentialing Department at Credentialing@SuperiorHealthPlan.com or 1-800-820-5686.