Important Forms

There are many forms you may need for medical or dental checkups. You can access many of these through Health Passport or print and fill out any of the following forms for your appointments. If you do not have Acrobat Reader, please install Acrobat Reader.

• Health Passport Form Coversheet (PDF)

Behavioral Health Forms

• Initial and Monthly Behavioral Health Assessment (PDF)

Dental Form

• Dental Form (PDF)

Texas Health Steps Forms

Mental Health Interview Referral Forms

• Ages 0-2 years (PDF)
• Ages 3-9 years (PDF)
• Ages 10-12 years (PDF)
• Ages 13-20 years (PDF)
• TB Questionnaire (PDF)

Other Forms

• Non-Consent Emergency Care Notification (PDF)
• Child Health History (PDF)
• Hearing Checklist (PDF)
• HHS Texas Health Steps Providers Resources
  
• Lead Poisoning Questionnaire (PDF)
• Notification of Pregnancy (PDF)
• Primary Care Provider (PCP) Change Request Form (PDF)
• Electronic Visit Verification (EVV) Rights and Responsibilities (PDF)

Credentialing Verification Organization (CVO)

Superior requires the utilization of the statewide Texas Credentialing Alliance and the contracted Credentialing Verification Organization (CVO) as part of the credentialing and re-credentialing process. Please reference TAHP Introduction to the Texas Credentialing Verification Organization (PDF) or the TAHP Credentialing website. 

Providers are required to complete the Texas Standard Credentialing Application (TSCA) for practitioners or the Superior Facility Credentialing Application for facilities.

• The Required 2007 TSCA is found on the Texas Department of Insurance website.(noted as Application Package)
• Aperture (the CVO services provider) will assist with a provider’s credentialing process for Superior HealthPlan. Credentialing documents are submitted to Aperture through CAQH or Availity.  
• To submit a practitioner application to CAQH, go to the CAQH website. A practitioner will need to register as a first time user to get started.
• To submit a practitioner or facility credentialing application to Availity, go to the Availity website. Superior will accept the Facility and Ancillary Application (link below) as an alternative option to Availity, and will forward the application on to Aperture upon receipt.
• Once the completed application is processed through Availity or CAQH, Aperture automatically retrieves the submitted information and performs the primary source verifications of submitted credentials.
• Aperture verifies the credentialing application and returns results to Superior for a credentialing decision.