News

Effective May 1, 2023: Clinical Policies

Date: 01/19/23

Superior HealthPlan has added certain clinical 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 May 1, 2023, at 12:00AM.

POLICY	APPLICABLE PRODUCTS	NEW POLICY OVERVIEW OR UPDATED POLICY REVISIONS
Influenza Testing (TX.CP.MP.115)	Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), MMP, and CHIP	New Policy includes: Policy statement overview of testing timeframes Background regarding the testing, treatment decisions, and diagnosis Pertinent CPT codes
Medical Necessity Criteria (TX.CP.MP.500)	Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), MMP, and CHIP	New Policy includes: Criteria for members birth through age 20, as well as members over 20 years of age Further guidance for CHIP members in the form of definitions for use with regards to medical necessity determinations Delineated definitions

POLICY

APPLICABLE PRODUCTS

NEW POLICY OVERVIEW OR UPDATED POLICY REVISIONS

Influenza Testing

(TX.CP.MP.115)

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

New Policy includes:

Policy statement overview of testing timeframes
Background regarding the testing, treatment decisions, and diagnosis
Pertinent CPT codes

Medical Necessity Criteria

(TX.CP.MP.500)

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

New Policy includes:

Criteria for members birth through age 20, as well as members over 20 years of age
Further guidance for CHIP members in the form of definitions for use with regards to medical necessity determinations
Delineated definitions

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.