Our family of products is growing! Please select a county so we can determine whom best to help you. Providers must supply the requested clinical information/documentation within three (3) business days after the request. Please contact your plan for details. Value-Added Items and Services (VAIS) are not plan benefits and are not covered by the plan. For specific details, please refer to the Allwell from Superior HealthPlan Provider Manual. ET | TTY #711 Shop Online. Physical and behavioral health emergencies, life threatening conditions and post-stabilization services do not require prior authorization. 1-800-218-7508. Lets talk about what we can do to give you peace of mind. 3 business days denial, PRIOR AUTHORIZATIONNOTIFICATION TIMEFRAME, Medicaid (STAR, STAR+PLUS, STAR Kids and STAR Health), CHIP. Hello. Simply call Superior Member Services. The prescriber is not available to make a prior authorization request because it is after the prescribers office hours and the dispensing pharmacist determines it is an emergency situation. If you have questions please,contact Member Services. Providers should include a completed Authorization Request form and all required documentation and clinical information with an authorization request submitted through Fax. If you need help understanding the language being spoken, Superior has people who can help you on the phone or can go with you to a medical appointment. Clinician Administered Drugs (CAD): 1-866-683-5631, Radiology and Cardiac Imaging: 1-800-784-6864, Musculoskeletal Surgical Procedures: 1-833-409-5393, Orthodontics (STAR Health): 1-888-313-2883. These include the following Texas licensed Utilization Review Agents: You will need Adobe Reader to open PDFs on this site. Is this an HMO Out of Network service request. For specific details, please refer to the Medicare . New York City. It's part of our Quality Improvement (QI) Program. Simply call Superior Member Services. Prior authorization requests are rejected/returned back to the provider for resubmission, if one or more essential information elements are missing, invalid or illegible. requests for medical necessity review and approval through Superiors contracted Utilization Review Agents (URA). or verbal notice containing the details of the incomplete/insufficient clinical documentation is delivered to the provider via fax or phone, within three (3) business days after receipt of a prior . If you need help understanding the language being spoken, Superior has people who can help you on the phone or can go with you to a medical appointment. Providers, please use this form to submit your questions related to Wellcare By Allwell (Medicare Advantage). You will need Adobe Reader to open PDFs on this site. Value-Added Items and Services (VAIS) are not plan benefits and are not covered by the plan. Coverage Determinations and Redeterminations, Prior Authorization, Step Therapy, & Quantity Limitations. Plan enrollees are responsible for all costs. If the medical necessity of a prior authorization cannot be confirmed by clinical staff, a Texas licensed physician/medical director reviews the case, and includes the opportunity for a peer discussion with the rendering/ordering provider prior to issuing any adverse determination. 2023 Medicare and PDP Compare Plans and Enroll Now. Medical Management provides notice of the determination of approval or denial of the prior authorization request within three business days after receipt of a complete prior authorization request. Get Adobe Reader. ET, Sat - Sun 10 a.m. - 7 p.m. For the most updated information or to re-enroll, please visit, Request Network Participation, Non-Contracted Providers Only, Add a Provider to an Existing Group Contract, Add a Practice Location to an Existing Contract, Practice Improvement Resource Center (PIRC), Updating Provider Demographic Information, Effective 1/1: Electronic Prescribing of Controlled Substances Required, Effective September 1, 2021: Benefit Changes to Total Disc Arthroplasty for Medicaid and CHIP, Effective July 15, 2021 through December 31, 2021: Temporary Relaxation of Prior Authorization Requirements for DME, Orthotic, and Enteral/Parenteral Nutrition and Medical Supplies, Javelina legend and NFL hall of famer Darrell Green gives back to Kingsville, Superior HealthPlan, Pro Football Hall of Famer Darrell Green Help Make First Back-to-School Community Fair & Fest in Kingsville a Success, Provider Notice of Adverse Benefit Determinations, Superior to Override Timely Filing for Claims Impacted by Texas Medicaid Healthcare Partnerships (TMHP) Eligibility Verification Issues, Ambetter from Superior HealthPlan - Provider Resources, Wellcare By Allwell Qualified Medicare Beneficiaries FAQ (PDF), Balance Billing: Superior Medicaid and CHIP (PDF), Balance Billing: Wellcare By Allwell and STAR+PLUS MMP (PDF), Superior HealthPlan Telemedicine Quick Reference Chart (PDF), TurningPoint Procedure Coding and Medical Policy Information (PDF), Ontrak Program Service Claims - Frequently Asked Questions (PDF), EVV Compliance Job Aid for Consumer Directed Services Employers (PDF), EVV Compliance Job Aid for Program Providers and FMSAs (PDF), HHS EVV Aggregator and EVV Portal Webinar (PDF), HHS EVV Home Health Care Services Bill Codes Table (PDF), HHS EVV Next Steps and Timeline for Transition to HHAeXchange (PDF), HHS EVV Provider Stakeholder Presentation (PDF), HHS EVV Responsibilities and Additional Information, 1718 Form (PDF), HHS EVV Temporary EVV Policies for Severe Winter Weather (PDF), HHS EVV Temporary Policies for COVID-19 (PDF), HHS EVV Vendor Selection for Cures Act EVV Expansion (PDF), HHS EVV Tool Kit - EVV Visit Maintenance and Transactions (PDF), HHS EVV Tool Kit Module 1 - Introduction to EVV (PDF), HHS EVV Tool Kit Module 2 - EVV Roles and Responsibilities (Part 1) (PDF), HHS EVV Tool Kit Module 3 - EVV Roles and Responsibilities (Part 2) (PDF), HHS EVV Tool Kit Module 4 - EVV Visit Transactions (PDF), HHS EVV Tool Kit Module 5 - EVV Visit Maintenance (PDF), HHS EVV Tool Kit Module 6 - EVV Process Flow (PDF), HHS EVV Tool Kit Module 7 - EVV Aggregator and Portal (PDF), HHS EVV Tool Kit Module 8 - Submitting an EVV Claim (PDF), HHS EVV Tool Kit Module 9 - EVV Portal Standard Reports and Search Tools (PDF), HHS EVV Tool Kit Module 10 - EVV Visit Transaction Validation Enhancements (PDF), HHS EVV Tool Kit Module 11 - Summary of EVV Changes (Part 1) (PDF), HHS EVV Tool Kit Module 12 - Getting Started - Next Steps (PDF), HHS EVV Tool Kit Module 13 - EVV Training Requirements (PDF), HHS EVV Roadshow Instructor-lead Training Schedule, Summer-Fall (PDF), HHS EVV Tool Kit Module 14 - EVV Compliance Oversight Policies (PDF), HHS EVV Tool Kit Module 15 - Best Practices to Avoid EVV Claim Mismatches (PDF), TMHP Electronic Visit Verification (EVV) FAQ (PDF), Visit Maintenance Unlock Request for Program Provider and FMSA (Excel), Visit Maintenance Unlock Request for Consumer Directed Services Employers (Excel), Drugs of Abuse and Genetic/Molecular Diagnostic Testing Prior Authorization Notice (PDF), Drugs of Abuse Prior Authorization Code List (PDF), Preferred DME Supplier (Medline) FAQ (PDF), Preferred DME Supplier (Medline) Supplies Available without Prior Authorization List (PDF), Prior Authorization List - Medicaid (PDF), Skilled Nursing Requirements Checklist (PDF), Vehicle Modification Request Packet - STAR+PLUS(PDF), Vehicle Modification Request Packet - STAR+PLUS Medicare-Medicaid Plan (MMP)(PDF), Addendum to Billing Methodology for PDN Multiple Ratio with Hospital Admission Event (PDF), Billing Guide for Member to Nurse Ratios (PDF), Medical Criteria, Parameters for Medically Necessary Hours and Exceptions Process (PDF), Private Duty Nursing Requirements Checklist (PDF), Nusing Facility Credentialing Frequently Asked Questions (PDF), Acute Care and Hospitals Quick Reference Guide (PDF), Case Management for Children and Pregnant Women (CPW) Quick Reference Guide (PDF), Centers for Medicare & Medicaid Services Website Resources (PDF), Direct Payment Program Frequently Asked Questions (PDF), FQHC Payment Process Quick Reference Guide (PDF), HEDIS Guidelines for Monitoring for Patients on PersistentMedications (PDF), Ophthalmology Quick Reference Guide (PDF), Rural Health Clinic (RHC) Billing Guidelines - Quick Reference Guide (PDF), STAR+PLUS Long-Term Services (LTSS) and Supports Rate Guide (PDF), STAR+PLUS LTSS Quick Reference Guide (PDF), STAR+PLUS MMP Quick Reference Guide (PDF), Wellcare By Allwell Quick Reference Guide (PDF), Wellcare vs. Wellcare By Allwell Guide (PDF), Early Childhood Intervention - Individualized Family Service Plan Information (PDF), Therapy Fee Schedule for Comprehensive Outpatient Rehabilitation Facility (Effective 9/1/17) (PDF), Therapy Fee Schedule for Home Health (Effective 9/1/17) (PDF), Therapy Fee Schedule for Individual Therapist Group (Effective 9/1/17) (PDF), Therapy Prior Authorization Requests: Clinical Documentation Criteria Quick Reference Guide (PDF), HHS Provider Notice: Texas Health Steps Document Improvement (PDF), HHS Texas Health Steps Information Flyer (PDF), Texas Health Steps Clinical Record Review Tool (PDF), Texas Health Steps Clinical Record Review Tool and Instructions, Texas Health Steps Medical Checkup Components and Provider Reference Guide (PDF), Texas Health Steps Online Provider Education, Texas Health Steps Regional Provider Relations Representatives Contact List, Texas Health Steps Quick Reference Guide (PDF), CTI-EBP Fair Housing and Reasonable Accommodations (Online Training), Guidelines on After Hours Telephone Accessibility (PDF), National Kidney Foundation - Chronic Kidney Disease (CKD) Risk Assessment Tool (PDF), HHS Early Childhood Intervention Services, HHS Policy Clarification:Span of Coverage (PDF), Prenatal Screening for Domestic Violence and Substance Use, Submit Attestations Online for Chronically Ill Members, Texas Health and Human Services Provider Fraud Notice (PDF), The Attorney General of Texas Initiative Combatting Sexual Exploitation (Human Trafficking). All's Well is an ActOne Group company, The field 'Your Email Address' does not appear to be valid, The field 'Phone Number' does not appear to be valid, Employee Timecards / My.Allswell.Com Login. Members:call the number on the back of your ID card orgo to the plan site. Superior HealthPlan provides the tools and support you need to deliver the best quality of care. Wellcare is the Medicare brand for Centene Corporation, an HMO, PPO, PFFS, PDP plan with a Medicare contract and is an approved Part D Sponsor. Wellcare By Allwell. All attempts are made to provide the most current information on the Pre-Auth Needed Tool. Members: call the number on the back of your ID card or go to the plan site. Forum II Building Prior authorization requests can be submitted by phone, fax or online through theSecure Provider Portal. Address & Phone Texas Headquarters: 5900 E. Ben White Blvd. Autism Applied Behavioral Analysis Provider Orientation (PDF), Autism Benefit Services Initial/Continued Treatment Plan Template (PDF), Autism Benefit Services Request for Initial Evaluation (PDF), NIA: Interventional Pain Management Quick Reference Guide (QRG) (PDF), NIA: Interventional Pain Management Frequently Asked Questions (FAQ) (PDF), NIA: High Tech Imaging QRG for Rendering Facilities (PDF), NIA: High Tech Imaging QRG for Ordering Physicians (PDF), NIA: Genetic and Molecular Testing Frequently Asked Questions (FAQ) (PDF), NIA: Genetic and Molecular Testing Quick Reference Guide (QRG) (PDF), NIA: Physical Medicine (Therapy) Quick Reference Guide (QRG), NIA: Physical Medicine (Therapy) Frequently Asked Questions (FAQ), 2021 Medicaid Prior Authorization Annual Review Report (PDF), 2021 Medicaid Prior Authorization Change Log (PDF), 2020 Medicaid Prior Authorization Annual Review Report (PDF), 2020 Medicaid Prior Authorization Change Log (PDF), Medicare Prior Authorization List Effective January 1, 2022 (PDF), Medicare Prior Authorization List Effective July 1, 2022 (PDF), Medicare Prior Authorization List Effective October 1, 2022 (PDF), Superiors Clinical Prior Authorization webpage. To ensure that the medical necessity review of a prior authorization request can be timely processed for determination, the following information must be included with each prior authorization request: Member information (Member name, Member DOB, Member Medicaid or CHIP ID number); and, Provider information (Rendering provider name, NPI, TIN; and, Specification and description of service, supply, equipment, or CAD procedural/service code(s) and description (CPT, HCPC, NDC); and, Pertinent diagnosis/conditions that relate to the need for the service (ICD-10); and, Objective clinical information necessary to support medical necessity for the requested service; and. Is the member being admitted to an inpatient facility? Those requests will be reviewed to determine the medical necessity of approving the delivery of care outside of Superiors contracted provider network, for those situations in which no contracted provider is available to deliver the applicable service. Medicaid prior authorization requests must include. Broker Self-Service Portal If you have questions, pleasecontact Member Services. Wellcare by Allwell (HMO and HMO SNP) includes products th. NA2PROMAN80542E_0000 Box 31383 You have a wide variety of primary care physicians, specialists, hospitals and outpatient facilities to choose from. We do this by providing daily care according to the highest standards, and delivered with skill and compassion. Because protecting peoples' health is why we're here, and it's what we'll always do. Prior authorization is required before the provision of all non-emergent health-care services, supplies, equipment and Clinician Administered Drugs (CAD) delivered by a provider that is not contracted with Superior. The member/patient receives a written notice of the request for submission of the incomplete clinical information. Prior authorization is NOT required for any urgent/emergent inpatient admissions that were not prior scheduled. THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES OFFICE OF INSPECTOR GENERAL IS ALERTING THE PUBLIC ABOUT A FRAUD SCHEME INVOLVING GENETIC TESTING. Please reference the sections below for additional prior authorization requirements and information. PHI includes member ID, member date of birth, claim number, etc. phone 716.826.6245 fax 716.826.6083 [email protected]. 2023 Medicare and PDP Compare Plans and Enroll Now. Are anesthesia services being requested for pain management, dental surgery or services in the office rendered by a non-participating provider? Enrollment in our plans depends on contract renewal. Our D-SNP plans have a contract with the state Medicaid program. 7700 Forsyth Boulevard St. Louis, MO 63105 Please address lien and subrogation requests to the Plan at: The Rawlings Company Post Office Box 2000 La Grange, KY 40031 Return to top Brokers For Broker support, contact the Broker Support Call Center at: 866-822-1339 Monday - Friday, 8 a.m. to 8 p.m. Copyright 2023 Centene Corporation. *. For specific details, please refer to the Allwell from Superior HealthPlan Provider Manual. Medicare Advantage plans for seniors and those with disabilities, sponsored by Ascension, one of the largest non-profit U.S. Catholic health systems, Before Calling: Check the Medicare Benefit Summary, Medicare Advantage plans for seniors and those with disabilities, Provider Services for Wellcare by Allwell. Call today for Medicare benefits you deserve. Email * Provide expertise for product innovation and development. All essential information must be included on each PA request. Copyright 2023 Centene Corporation. Texas Medicaid Provider Procedures Manual (Medicaid) .