Prior Authorization (Part C)

What is Prior Authorization?

Prior Authorization is a process which must be completed before you get some services. Some services must get prior authorization, also called Prior Approval, before the plan will pay for it. Your doctor will make the request. You can make the request also. We will need medical records and notes from your doctor. Other information that shows why you need the item or service will be needed. Call your doctor if you need this information. This will help us know if the service is medically needed.

What services require Prior Authorization?

To get a list of services that require prior authorization, please contact Superior HealthPlan (Superior) STAR+PLUS Medicare-Medicaid Plan (MMP) at 1-800-218-7508 (TTY: 711).

For out-of-network services you must get Prior Authorization. You do not need Prior Authorization for emergencies. Out-of-area urgent care or dialysis does not need Prior Authorization.

What is the process for getting Prior Authorization?

You may get Prior Authorization by calling Superior HealthPlan STAR+PLUS MMP at 1-800-218-7508 (TTY: 711).

Providers need to send Prior Authorizations through the web portal, by phone or by fax.

If your doctor wants you to get services or an item quickly, we will tell you if the service is approved.  We will tell you within 1 (one) business day after we get your request. This is what we call a Fast decision.

You will be told no later than 3 (three) business days for all other requests.

If we find that your health may be in danger we will hurry your request.

We will tell you what we decide in writing or by telephone. In the case of an emergency, you do not need Prior Authorization.

Prior Authorization is not a guarantee of payment. Superior HealthPlan STAR+PLUS MMP has the right to review the service for medical need after you receive the services. The member must be eligible for services. Some services have limits. Some benefits have exclusions.

Last Updated: 10/01/2016