For Providers

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If you are a contracted Superior HealthPlan provider, you can register now. If you are a non-contracted provider, you will be able to register after you submit your first claim. 

Once you have created an account, you can use the Superior HealthPlan provider portal to: 

  • Verify member eligibility
  • Manage claims
  • Manage authorizations
  • View patient list
  • Login/Register
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Join Our Network

Thank you for your interest in becoming a Superior HealthPlan network provider. We look forward to working with you to improve the health of the community.

join our network

Login  

If you are a contracted Superior HealthPlan provider, you can register now to access one of the secure provider portals linked below. If you are a non-contracted provider, you will be able to register after you submit your first claim. 

Once you have created an account, you can use the Superior HealthPlan secure provider portal to: 

  • Verify member eligibility
  • Manage claims
  • Manage authorizations
  • View patient list
  • Login/Register

Join Our Network

Thank you for your interest in becoming a Superior HealthPlan network provider. We look forward to working with you to improve the health of the community.

join our network

Click Here to Contact Your Account Manager

Contact Provider Services:

Contact Provider Services for information or questions on benefits, claims, authorizations and billing inquiries.

In order to expedite your call, please have the following: Tax Identification number, NPI, member ID, DOB, billed amount and date of service available.

Ambetter from Superior HealthPlan
1-877-687-1196

CHIP, CHIP RSA, STAR, STAR+PLUS, STAR+PLUS MMP, STAR Kids and Medicare Advantage
1-877-391-5921

STAR Health (Foster Care)
1-877-391-5921

Office Hours: 8:00 a.m. to 5:00 p.m. CST / 8:00 a.m. to 6:00 p.m. CST (STAR Health only)

After office hours, Superior’s STAR Kids nurse advice line staff is available to answer questions and intake requests for prior authorization by calling 1-844-590-4883.

Have a comment or question? Please Contact Us

Please note: If one of Superior’s web-based systems or provider is unavailable or having technical issues, a notice will be posted on Superior’s website under Provider News.

 

Provider News

January

Notice to Physicians and Providers

01/06/25

Superior HealthPlan Inc., a licensed HMO in Texas, provides Medicare, Medicaid, CHIP and commercial benefits to eligible members. Superior HealthPlan Network, a licensed EPO in Texas provides Medicaid and CHIP benefits to eligible members in rural service areas. Celtic Insurance Company (Ambetter from Superior HealthPlan), a licensed EPO, provides commercial benefits to eligible members. Application can be made to participate at any time. 5900 E. Ben White Blvd., Austin, TX 78741.

December

Effective March 31, 2025: New and Revised Clinical Payment Policies

12/30/24

Superior HealthPlan, Ambetter from Superior HealthPlan and Wellcare By Allwell present new and revised clinical payment policies as detailed below. As a result, the following policies have been posted on Superior's Clinical, Payment and Pharmacy Policies webpage for awareness, prior to implementation:

Effective April 1, 2025: Sleep Studies Clinical Policies

12/27/24

Superior HealthPlan has added/updated certain policies to ensure medical necessity review criteria is current and appropriate for members and the scope of services provided. As a result, the following policies are effective on April 1, 2025.

Payment Policy Posting and Updates

12/20/24

Superior HealthPlan, Ambetter from Superior HealthPlan and Wellcare By Allwell present new and existing payment policies as detailed.

Effective April 1, 2025: Transition of Utilization Review for Sleep Studies

12/19/24

Effective April 1, 2025, prior authorization requests for sleep studies will transition from TurningPoint Healthcare Solutions, LLC, Texas Utilization Review Agent (URA) #2395464 to Centene Management Company, LLC, Texas URA #5396 for Superior HealthPlan Medicaid (STAR, STAR+PLUS, STAR Health and STAR Kids), CHIP, STAR+PLUS Medicare-Medicaid Plan (MMP) and Ambetter from Superior HealthPlan (Marketplace) members.

Medicaid Partial Hospitalization Program and Intensive Outpatient Program Mental Health and Substance Use Disorder (SUD) Services Available

12/19/24

Superior HealthPlan's provider network includes facilities who provide Partial Hospitalization Program (PHP) and Intensive Outpatient Program (IOP) as In Lieu of Services (ILOS). ILOS may be provided as an option to inpatient psychiatric hospitalization for Medicaid (STAR, STAR+PLUS, and STAR Health) adult members over 20 years of age.

IMPORTANT: HHSC Medicaid Provider Enrollment Revalidation Flexibilities

12/18/24

The Texas Health and Human Services Commission (HHSC) has provided information that Medicaid provider enrollment flexibilities have been initiated to ensure that eligible and/or currently enrolled Medicaid providers can continue to provide services for managed care Medicaid members and be reimbursed for the provision of services. Medicaid provider enrollment revalidation must be completed every three years to maintain active Medicaid enrollment status.

Effective January 1, 2025: Pharmacy and Biopharmacy Policies

12/18/24

Superior HealthPlan has added, updated or retired certain pharmacy and biopharmacy policies to ensure medical necessity review criteria is current and appropriate for members and the scope of services provided. As a result, the following policies are effective on January 1, 2025, at 12:00AM.

Effective March 1, 2025: Pharmacy and Biopharmacy Policies

12/18/24

Superior HealthPlan has added, updated or retired certain pharmacy and biopharmacy policies to ensure medical necessity review criteria is current and appropriate for members and the scope of services provided. As a result the following policies are effective on March 1, 2025 at 12:00AM.

Effective October 1, 2024: Pharmacy and Biopharmacy Policies

12/17/24

Superior HealthPlan has added, updated, or retired certain pharmacy and biopharmacy policies to ensure medical necessity review criteria is current and appropriate for members and the scope of services provided. As a result, the following policies are effective on October 1, 2024, at 12:00AM.
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