Prior authorization phone assistance for members and providers is available on weekdays from 8am – 5pm in all time zones in Texas. Medicaid Pharmacy Prior Authorization & Preferred Drug List Rev.
Copyright © 2020 Texas Children's Health Plan. Instructions. Those requests will be reviewed to determine the medical necessity of approving the delivery of care outside of Superior’s contracted provider network, for those situations in which no contracted provider is available to deliver the applicable service. Following notification of admission, concurrent and/or retrospective utilization review is conducted to confirm the continued medical necessity of the inpatient stay. Facility providers should reference the Professional services provided during a medically necessary inpatient admission do not require separate authorization.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.It is the responsibility of the rendering, ordering or referring practitioner to initiate the request for prior authorization for non-contracted provider health care services. All Rights Reserved.If you feel you or your loved ones have been exposed to the Coronavirus (COVID-19), please do one of the following:Call our 24 hour nurse help line at 1-800-686-3831 or TDD 1-800-735-2989Texas Children’s Health Plan offers TDD.TTY services for deaf, hard of hearing or speech impaired members and providers.
Contact information for all services that require prior authorization are included below: Prior Authorization Phone Numbers: Physical … UnitedHealthcare Community Plan of Texas annually reviews our health plan prior authorization policies in accordance with Texas Government Code Section §533.00283. Texas Children’s Health Plan then decides whether to approve or deny your provider’s request. Simply call The Prior Authorization Reconsideration Request Form is required to initiate a request for reconsideration of a previously denied prior authorization. The form provides a brief description of the steps for reconsideration and is only for patients enrolled in Medicaid … These include the following Texas licensed utilization review entities:You will need Adobe Reader to open PDFs on this site.You will need Adobe Reader to open PDFs on this site.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.
These include non-elective, inpatient admissions, including those that are subsequent to emergency services and stabilization of the patient, which do not require prior authorization.All inpatient confinements do require ‘notification’ of the admission no later than the next business day after the date of admission. You can also request any materials on this website in another format, such as large print, braille, CD or in another language. If a contracted provider is available for provision of the requested service, the prior authorization request may be denied with redirection to a contracted provider. Updated: 2/2018 Purpose. Other medically necessary pharmacy services or products are covered consistent with VDP guidance.For a full listing of prior authorization requirements, please visit the following links:Medicaid (STAR, STAR+PLUS, STAR Kids and STAR Health)Medicaid (STAR, STAR+PLUS, STAR Kids and STAR Health), CHIPSuperior HealthPlan contracts with several licensed Utilization Review Agents (URAs) who have the clinical expertise to conduct in tthe utilization review of for applicable prior authorization service requests. Superior HealthPlan is responsible for ensuring the medical necessity and appropriateness of all health-care services for enrolled members. Texas Children’s Health Plan will also include a copy of the letter sent to the Medicaid provider describing the documentation/information that needs to be submitted.