Medicaid and CHIP Prior Authorization
All attempts are made to provide the most current information on the Pre-Auth Needed Tool. However, this does NOT guarantee payment. Payment of claims is dependent on eligibility, covered benefits, provider contracts, correct coding and billing practices. For specific details, please refer to the provider manual. If you are uncertain that prior authorization is needed, please submit a request for an accurate response.
Dental services need to be verified by DentaQuest.
Ear, Nose and Throat (ENT) Surgeries, Sleep Study Management and Cardiac Surgeries Need to be Verified by TurningPoint.
Musculoskeletal (MSK) Surgical Procedures, Genetic Testing, Imaging, Interventional Pain Management to be verified by Evolent (formerly known as NIA).
Non-participating providers must submit prior authorization for all services*
For non-participating providers, Join Our Network
*Please note, Incontinence Supplies ordered through the preferred DME provider do not require prior authorization.
Would this be for Family Planning services billed with a contraceptive management diagnosis OR Is this service for a Star Kids or Star Health Member for school based telemedicine?
| Types of Services | YES | NO |
|---|---|---|
| Are services being provided by a non-participating provider? | ||
| Is the member being admitted to an inpatient facility? | ||
| Is the member receiving oral surgery services? | ||
| Is this service for Home Visits by Home Health, Home Infusion, Physical, Occupational & Speech Therapist, in a Home Location. |
To submit a prior authorization Login Here.
To access prior authorization lists, please visit Superior’s Prior Authorization Requirements webpage.
To access Superior clinical and payment policies, visit Clinical & Payment Polices.