A Guide to Understanding Credentialing

Date: 04/15/19

Superior's Credentialing Department utilizes a rigorous process to evaluate and select providers who will serve our members. Each provider must meet minimum qualifications, established by Superior and outlined by the National Committee for Quality Assurance (NCQA), State licensing agencies and the Texas Department of Insurance (TDI).

During the credentialing and re-credentialing process, provider backgrounds and expertise are verified through several accredited primary sources, including:

• State licensing agencies
• The National Practitioner Data Bank
• The Office of Inspector General

All providers participating with Superior have the right to:

• Review information and materials acquired from select primary sources and correct erroneous information.
• Request the status of credentialing or re-credentialing applications at any time.

To review information obtained during the credentialing process, providers must submit a written request to:

Superior HealthPlan
Attn: Credentialing Department
5900 E. Ben White Blvd.
Austin, TX 78741

Superior may request clarification from the provider, if any information differs from documentation submitted by the provider. It is the provider’s responsibility to submit all necessary information within 30 days of being informed of the discrepancy. Superior’s Credentialing Department will conduct a thorough examination and ensure timely determination, as defined by State contractual obligations.

Superior’s Credentialing Department can also assist providers interested in pursuing leadership opportunities, such as service on one of Superior’s Quality Committees or appeal panels. For questions, requests or more information, please reach out to Superior’s Credentialing Department at Credentialing@SuperiorHealthPlan.com or call 1-800-820-5686 ext. 22281.