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 STAR+PLUS 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 STAR+PLUS 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 STAR+PLUS 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 STAR+PLUS 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.

If you have additional questions, please refer to your Member Handbook, or call Member Services at 1-866-896-1844. Hours are from 8 a.m. to 8 p.m., Monday through Friday. After hours, on weekends and on holidays, you may be asked to leave a message. Your call will be returned the next business day. TTY users call 711.