HAVE AN ENROLLMENT NEED? SHOP OUR PLANS
Pre-Auth Tool | Ambetter from Superior HealthPlan
All attempts are made to provide the most current information on the Pre-Auth Needed Tool. However, this does NOT guarantee payment. Payment of claims is dependent on eligibility, covered benefits, provider contracts, correct coding and billing practices. For specific details, please refer to the provider manual. If you are uncertain that prior authorization is needed, please submit a request for an accurate response.
Vision services, including all services rendered by an Optician, Ophthalmologist, or Optometrist need to be verified by Envolve Vision
Dental services need to be verified by Envolve Dental
Musculoskeletal Services need to be verified by TurningPoint. Effective May 1, 2021, Ear, Nose and Throat (ENT) Surgeries, Sleep Study Management and Cardiac Surgeries need to be verified by Turning Point. Please contact TurningPoint by phone (1-855-336-4391) or fax (1-214-306-9323).
Complex imaging, MRA, MRI, PET, and CT Scans, as well as Speech, Occupational and Physical Therapy need to be verified by NIA. For Chiropractic providers, no authorization is required for therapy services.
Services provided by Out-of-Network providers are not covered by the plan. Join Our Network
Are Services being performed in the Emergency Department?
|Types of Services||YES||NO|
|Are the services being performed or ordered by a non-participating provider?|
|Is the member being admitted to an inpatient facility?|
|Are anesthesia services being rendered for dental surgeries?|
|Is the member receiving Gender Reassignment services?|