Provider Notice of Adverse Benefit Determinations

Date: 04/08/22

Some Superior HealthPlan providers have been receiving a fax notification in advance of the receipt of the adverse determination benefit notice when a request for prior authorization is denied.

We acknowledge that this additional correspondence to provider offices is an additional communication that adds to provider incoming correspondence unnecessarily, and is duplication of the regulatory-required communication of adverse benefit determinations to members and providers.

In an effort to reduce administrative work for providers, Superior will eliminate the fax communication denial notice effective May 15, 2022. Superior will include all regulatory-required and clinical details in the Provider Notice of Adverse Benefit Determinations, in response to applicable prior authorization requests.   

For any questions, please contact your local Account Manager.