Prior Authorization Form Update for Continuity of Care

Date: 07/31/18

The Superior HealthPlan Request for Prior Authorization Form has been updated to include a “Continuity of Care” checkbox. This added form field helps Superior identify and respond to prior authorization requests that involve continuity of care, based on prior authorization by The Texas Medicaid & Healthcare Partnership (TMHP) or another Managed Care Organization (MCO).

Please utilize this checkbox (indicated in red in the sample below) when a new Superior member requires prior authorization for service from a previous TMHP or MCO. Providers should continue to include a copy of the prior authorization letter with the request documentation submitted to Superior.

 

To download the Superior HealthPlan Request for Prior Authorization Form, please visit Superior’s Provider Forms webpage.

Please note: Providers who utilize the Texas Department of Insurance (TDI) Texas Standard Prior Authorization Request Form, which is also located on Superior’s Provider Forms webpage, may specify Continuity of Care by checking “Urgent” as the Review Type and writing “Continuity of Care” as the Clinical Reason for Urgency, indicated in red in the sample below:

For questions, please reach out to your local Account Manager.