News
Effective January 1, 2023: Ambetter Clinician-Administered Drug Prior Authorization Update
Date: 11/02/22
Ambetter from Superior HealthPlan requires Prior Authorization (PA) as a condition of payment for many Clinician-Administered Drugs (CADs) provided to Ambetter members. Effective January 1, 2023, the following changes to PA requirements will take effect:
HCPCS Code | Description | Prior Authorization Requirements |
|---|---|---|
A9590 | IODINE I-131 IOBENGUANE 1 MCI | Pre-authorization is required for all providers |
A9699 | SPL RADOPHRM TX IMAG AGT NOC | Pre-authorization is required for all providers |
Providers may submit a PA request by:
- Utilizing Superior’s Secure Provider Portal.
- If you are not currently registered on the portal, registration is quick and simple.
- Faxing an authorization to the Superior HealthPlan Pharmacy Department at 1-800-690-7030.
As a reminder, providers may determine which specific codes require PA by visiting Superior's Pre-Auth Needed Tool and selecting Ambetter.
For questions regarding this information, please contact your dedicated Account Manager or call Provider Services at 1-877-687-1196.