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NIA Expansion: Outpatient Rehabilitative and Habilitative Therapy Services

Date: 05/21/21

Superior HealthPlan is expanding our partnership with National Imaging Associates, Inc. (NIA) to include utilization review of outpatient physical, occupational and speech therapy treatment services for Superior Medicaid (STAR, STAR+PLUS*), and CHIP members.

*Please note: For Medicaid STAR+PLUS members, this expansion is only applicable to members receiving non-waiver services.

The effective date for this expansion has been extended to November 1, 2021. Prior authorization must be requested through NIA for any therapy treatment scheduled to occur on or after November 1, 2021. Authorizations can be obtained through NIA at www.RadMD.com or by calling 1-800-642-7554.

Important to Note:

  • Superior will continue to process prior authorization requests for therapy treatment for STAR Kids, STAR Health, STAR+PLUS MMP, and STAR+PLUS HCBS Waiver members only. 
  • Services requiring prior authorization through NIA for STAR, STAR+PLUS, and CHIP members include therapy treatment performed in an outpatient or home setting and only when performed by in-network physical therapists, occupational therapists and speech language pathologists.
  • Prior authorization requests for therapy services delivered by out-of-network providers must be submitted to Superior.
  • Therapy evaluations will no longer require prior authorization, effective June 1, 2021.
  • For Travis/Central service delivery area, all current processes remain in place.
  • All claims for therapy services will continue to be processed by Superior. 

Training opportunities to review the NIA authorization process will be available on Superior’s Provider Training calendar.

As a reminder, member eligibility and benefits can be verified through Superior’s Secure Provider Portal or by calling Superior Member Services.

For questions related to Superior (claims, contract status, etc.) please contact Superior Provider Services at 1-877-391-5921.