Prior Authorization Requirements for Health Insurance Marketplace 

Ambetter from Superior HealthPlan (Ambetter) is responsible for ensuring the medical necessity and appropriateness of all health-care services for enrolled members. For some services, clinical review and prior authorization approval is required before the service is delivered.

A listing of the Ambetter covered services that require prior authorization may be accessed by visiting:

Health Insurance Marketplace Prior Authorization List (PDF)

Ambetter pre-authorization approval and denial rates for medical care or health-care services may be accessed by visiting: 

In addition, an electronic tool is available on Ambetter’s website that provides procedure code specific information for the services, supplies, equipment and Clinician Administered Drugs (CAD) that require prior authorization. To view the Ambetter Prior Authorization Prescreen Tool, access the link below:

Health Insurance Marketplace

For Medicaid and CHIP, Medicare and the STAR+PLUS MMP Prior Authorization Prescreen Tools, please visit:

Medicaid and CHIPMedicare Advantage | STAR+PLUS MMP

Please reference the sections below for additional prior authorization requirements and information.