Prior Auth Submission Change

Date: 04/15/19

Thank you for your continued partnership with Ambetter from Superior HealthPlan. We want to notify you of some upcoming changes to our behavioral health prior authorization forms that will help reduce administrative burden.

Summary of Change: Ambetter will be converting to a new prior authorization form for behavioral health services.

Why are these changes necessary? The new Prior Authorization Form is a single page and will allow providers to submit clinical data in any form.

What are the impacts of these changes? When the new form goes live, Ambetter will post parameters for supporting clinical documentation to help ensure providers submit the necessary information needed to make a determination.

What if I need assistance? The new behavioral health prior authorization form will be posted on the Provider Resources page of Ambetter.SuperiorHealthPlan.com. For any questions, please contact Ambetter’s Provider Services team at 1-877-687-1196.

As a reminder, behavioral health prior authorization requests may be submitted by faxing a prior authorization form to 1-844-307-4442.