Prior Authorization (Part C)

What is Prior Authorization?

Prior authorization means that you must get approval from Superior HealthPlan STAR+PLUS Medicare-Medicaid Plan (MMP) before you can get a specific service or drug or see an out-of-network provider. Superior HealthPlan STAR+PLUS Medicare-Medicaid Plan (MMP) may not cover the service or drug if you don’t get approval. If you need urgent or emergency care or out-of-area dialysis services, you don't need to get approval first.

Which services require Prior Authorization?

To get a list of services that require prior authorization, please refer to your Member Handbook or contact Superior HealthPlan STAR+PLUS Medicare-Medicaid Plan (MMP) at 1-866-896-1844 (TTY: 711).

What is the process for getting Prior Authorization?

Either you or your doctor may request a prior authorization.  Members should call Superior HealthPlan STAR+PLUS Medicare-Medicaid Plan (MMP) at 1-866-896-1844 (TTY: 711). Providers may submit a prior authorization by phone, fax or web.

If your doctor wants you to get services quickly, we will notify you if the service is approved within 1 (one) business day after we get your request.  If we find that your health may be in danger we will hurry your request.

For all other requests, you will receive a response within 3 (three) business days.

We will tell you our decision either in writing or by telephone. Please note that in the case of an emergency, you do NOT need Prior Authorization.

Prior authorization approval is not a guarantee of payment. Superior HealthPlan STAR+PLUS Medicare-Medicaid Plan (MMP) has the right to review all services for medical need after you receive the services. You must be eligible for the services you are requesting prior approval for. Some services have limits. Some benefits have exclusions.

Two Kinds of Appeals

Standard Appeal

If you do not like the choice we have made, you have the right to make an appeal. We will review our decision and let you know what we decide. You will get a written answer on a Standard Appeal 30 days after we receive your appeal. We may take longer if you ask for more time, or if we need to know more about your case. We will tell you if we are taking extra time and will explain why more time is needed. 

Fast Appeal

You can ask for a Fast Appeal if you or your doctor think your health could be in danger. You will get an answer within 72 hours after we get your appeal.

If your doctor asks for a Fast Appeal, you will get one.

If you want a Fast Appeal but your doctor did not ask, we may not approve it. 

If we don’t give you a Fast Appeal, we’ll give you an answer in 30 days.

What is Prior Authorization?

Prior authorization means that you must get approval from Superior HealthPlan STAR+PLUS Medicare-Medicaid Plan (MMP) before you can get a specific service or drug or see an out-of-network provider. Superior HealthPlan STAR+PLUS Medicare-Medicaid Plan (MMP) may not cover the service or drug if you don’t get approval. If you need urgent or emergency care or out-of-area dialysis services, you don't need to get approval first.

Which services require Prior Authorization?

To get a list of services that require prior authorization, please refer to your Member Handbook or contact Superior HealthPlan STAR+PLUS Medicare-Medicaid Plan (MMP) at 1-866-896-1844 (TTY: 711).

What is the process for getting Prior Authorization?

Either you or your doctor may request a prior authorization. Members should call Superior HealthPlan STAR+PLUS Medicare-Medicaid Plan (MMP) at 1-866-896-1844 (TTY: 711). Providers may submit a prior authorization by phone, fax or web.

If your doctor wants you to get services quickly, we will notify you if the service is approved within 1 (one) business day after we get your request. If we find that your health may be in danger we will hurry your request.

For all other requests, you will receive a response within 3 (three) business days.

We will tell you our decision either in writing or by telephone. Please note that in the case of an emergency, you do NOT need prior authorization.

Prior authorization approval is not a guarantee of payment. Superior HealthPlan STAR+PLUS Medicare-Medicaid Plan (MMP) has the right to review all services for medical need after you receive the services. You must be eligible for the services you are requesting prior approval for. Some services have limits. Some benefits have exclusions.

Two Kinds of Appeals

Standard Appeal

If you do not like the choice we have made, you have the right to make an appeal. We will review our decision and let you know what we decide. You will get a written answer on a Standard Appeal 30 days after we receive your appeal. We may take longer if you ask for more time, or if we need to know more about your case. We will tell you if we are taking extra time and will explain why more time is needed. 

Fast Appeal

You can ask for a Fast Appeal if you or your doctor think your health could be in danger. You will get an answer within 72 hours after we get your appeal.

If your doctor asks for a Fast Appeal, you will get one.

If you want a Fast Appeal but your doctor did not ask, we may not approve it. 

If we don’t give you a Fast Appeal, we’ll give you an answer in 30 days.