News

Effective January 31, 2023: Clinical Policies

Date: 01/25/23

Superior HealthPlan has updated certain policies to ensure medical necessity review criteria is current and appropriate for members and the scope of services provided. As a result the following policies are effective on January 31, 2023, at 12:00AM.

Changes in these policies reflect preauthorization requirement amendments that are less burdensome to insureds, physicians, or health care providers.

POLICY	APPLICABLE PRODUCTS	NEW POLICY OVERVIEW OR UPDATED POLICY REVISIONS
Diaphragmatic/Phrenic Nerve Stimulation (CP.MP.203)	Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), CHIP, and Ambetter	Policy updates include: Criteria II.A.1.c. and Criteria II.A.2.b. updated to include “or by other radiographic techniques such as ultrasound” in addition to fluoroscopy Background updated to include U.S. Food and Drug Administration premarket approval information regarding the Avery Spirit Diaphragm Pacing Transmitter ICD-10 codes removed
Drugs of Abuse: Definitive Testing (CP.MP.50)	Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), CHIP, and Ambetter	Policy updates include: Added protocols for prior authorization details: Testing for children < 6 years of age is exempt from prior authorization and requests for prior authorization will be accepted up to 10 business days after specimen collection and reviewed for medical necessity based on the above stated criteria

POLICY

APPLICABLE PRODUCTS

NEW POLICY OVERVIEW OR UPDATED POLICY REVISIONS

Diaphragmatic/Phrenic Nerve Stimulation

(CP.MP.203)

Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), CHIP, and Ambetter

Policy updates include:

Criteria II.A.1.c. and Criteria II.A.2.b. updated to include “or by other radiographic techniques such as ultrasound” in addition to fluoroscopy
Background updated to include U.S. Food and Drug Administration premarket approval information regarding the Avery Spirit Diaphragm Pacing Transmitter
ICD-10 codes removed

Drugs of Abuse: Definitive Testing

(CP.MP.50)

Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), CHIP, and Ambetter

Policy updates include:

Added protocols for prior authorization details: Testing for children < 6 years of age is exempt from prior authorization and requests for prior authorization will be accepted up to 10 business days after specimen collection and reviewed for medical necessity based on the above stated criteria

To review all policies, please visit Superior’s Clinical, Payment & Pharmacy Policies webpage.

Prior to updates, Medical Clinical policies are reviewed and approved by the Utilization Management Committee.

For questions or additional information, contact Superior HealthPlan Prior Authorization department at 1-800-218-7508.