Effective April 1, 2025: Transition of Utilization Review for Sleep Studies
Date: 12/19/24
Effective April 1, 2025, prior authorization requests for sleep studies will transition from TurningPoint Healthcare Solutions, LLC, Texas Utilization Review Agent (URA) #2395464 to Centene Management Company, LLC, Texas URA #5396 for Superior HealthPlan Medicaid (STAR, STAR+PLUS, STAR Health and STAR Kids), CHIP, STAR+PLUS Medicare-Medicaid Plan (MMP) and Ambetter from Superior HealthPlan (Marketplace) members.
Providers should continue to submit prior authorization requests to TurningPoint through March 31, 2025, regardless of the service dates being requested for medical necessity determination.
Beginning on April 1, 2025, all prior authorization requests for sleep studies must be submitted to the Centene Management Company URA through one of the following prior authorization request submission methods:
- Online:
- Phone:
- Fax:
- 1-800-690-7030
There will be no additional procedure codes that are subject to prior authorization associated with this transition on April 1, 2025.
Providers can use Superior’s Pre-Auth Needed Tool, via the links below, to verify prior authorization requirements for specific procedure codes.
- Medicaid and CHIP Prior Authorization webpage
- STAR+PLUS MMP Prior Authorization webpage
- Ambetter Pre-Auth Needed Tool
The clinical policy that will utilized for medical necessity determinations for sleep studies on and after April 1, 2025 will be posted and accessible for review and comment on January 1, 2025 on Superior’s Clinical, Payment & Pharmacy policies webpage. For questions, please contact your local Account Manager. To access their contact information visit Find My Account Manager.