Effective 3/18: New Outpatient Prior Authorization Forms and Fax Line Changes

Date: 02/02/21

Effective March 18, 2021, Superior HealthPlan will launch new outpatient fax forms for requesting Prior Authorization (PA) for transplant services with updated fax numbers listed on the forms. The new forms are formatted to be easily read by Superior’s fax processing systems, and will help complete PA requests quickly and more efficiently. All necessary clinical documentation must be submitted with the faxed authorization request form. Superior will continue to provide notification if necessary information, such as the Member ID or Provider’s Tax Identification Number (TIN), is not included on the submitted forms.

As a reminder, three methods are available for submitting PA requests to Superior:

1. Superior’s Secure Provider Portal
2. Fax
3. Phone

Changes to Outpatient Fax Forms

• Format of the authorization request form (included in this notification).
• Separate forms for outpatient services (specific to product type).
• Fax numbers will be located on the top right of the form. Please reference these numbers as the lines may have changed.

How to Complete the PA Forms

• Providers must complete each field of the authorization forms. Incomplete forms may be returned.
• For requests submitted by the servicing provider, providers should list themselves as the servicing provider.
• All requesting providers must include a valid contact phone number on the PA form, for both requesting and servicing providers. The phone numbers should be a direct line or include an extension to the requesting and servicing provider.   

PA Tips

• When submitting a PA form, please access the latest form from the appropriate section of Superior’s Provider Forms webpage.
• Submitting outdated PA forms or photocopied forms may result in a potential delay in receipt and/or processing.
• Submitted provider’s orders must be signed and dated, for required service types with the current PA request, in order to authenticate the requested service.
• For PA requirements, please reference the Superior HealthPlan STAR, CHIP, STAR+PLUS, STAR Health and STAR Kids Provider Manual (PDF).

For more information or any questions, please contact your local Account Manager.