Superior – Page 3

LexisNexis – Superior

If you receive a letter from LexisNexis requesting directory information for Superior, and you have opt’ed into POETs Superior Agreement, you do not need to fill this out. Please notify POET.

However, anytime you have demographic changes in your practice, POET needs to know as soon as possible. It is POET’s responsibility to provide that information to the insurance plans, you have opt’ed into with us. This includes but is not limited to:

Adding Provider to Practice
Address
Phone Number
Billing Address
Changes Concerning AHP
Office Manager Changes
Provider Leaving Practice
Practice Name Change
Office Manager Changes
TIN or NPI Changes

Superior Prior Auth Requirements

Superior will be ending any active prior authorizations for Synagis® effective February 1, 2022 for all Superior Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS) and CHIP members to align with HHS guidance. As the season has ended, claims for Synagis® will no longer adjudicate pursuant to the end of the season per VDP guidance.

Superior HealthPlan will require prior authorization for CPT code 81519, Oncology Breast MRNA, for Medicaid, CHIP and Superior HealthPlan Medicare-Medicaid Plan (MMP) members. Superior HealthPlan will utilize Change Healthcare’s InterQual as the medical necessity review criteria. Effective on May 1, 2022

PEMS will replace Provider Enrollment on the Portal (PEP) and the Provider Information Management System (PIMS).
PEP and PIMS will no longer be available.
Paper applications for Texas Medicaid provider enrollment will be eliminated with the new online system.
Providers must have access to the internet to utilize PEMS and use up-to-date internet browsers for optimum performance of the PEMS portal. Use Google Chrome or Microsoft Edge to reduce compatibility issues