Provider Toolkit: Quick Reference Guide

Simplify Office Administrative Tasks

Keep our Quick Reference Guide nearby to make pre-visit planning and post-visit tasks quick and easy.


Website: Ambetter.SuperiorHealthPlan.com


Secure Provider Portal: provider.superiorhealthplan.com

  • Verify member eligibility
  • Access patient health records
  • View patient gaps
  • Manage prior authorizations
  • Submit and manage claims
  • And more!

 



Member Eligibility

Check member eligibility via:

 



Patient Care Gaps

Find recommended services that a member has not completed.

  1. Visit the Secure Provider Portal.
  2. Review patient informationfor any gaps in care.
  3. Plan to address care gapsduring future appointment.

 



Prior Authorization

Use the Pre-Auth Needed tool on our website to determine if prior authorization is required.

Submit prior authorizations via:

  • Secure Provider Portal
  • Medical and Behavioral Fax (Outpatient): 1-855-537-3447
    Medical Fax (Inpatient): 1-866-838-7615
    Behavioral Fax (inpatient): 1-866-900-6918

 



Claims

Timely Filing guidelines: 95 days from date of service.

Claims can be submitted via:

  • Secure Portal
  • Clearinghouses: EDI Payor ID 68069
  • Mail paper claims to: P.O. Box 5010 | Farmington, MO 63640-5010

 

Pre-Visit Planning Checklist

 
 
 
  • Verify member eligibility.
  • Check for patient care gaps and address them during upcoming office visit.
  • Use Pre-Auth Needed tool to determine if prior authorization is needed before appointment.