Get Special Medical Prior Authorization (SMPA) Request Form

If you think more information or an additional form may be needed, please check the issuer's website before faxing or mailing your request. Please fax form to Superior HealthPlan at 1-866-399-0929.

Retroactive eligibility occurs when the effective date of a client's Medicaid coverage is before the date the client's Medicaid eligibility is added to TMHP's eligibility file, which is called the “add date.”

Except for emergency services, post-stabilization services, and services provided to you during an approved inpatient admission, all services from an out-of-network provider must be prior authorized. Claims for services from out-of-network providers that are not approved before the service is given may be denied.

Prior authorization (PA) may be required via BCBSTX's medical management, eviCore® healthcare, Carelon Medical Benefits Management effective March 1, 2023 (formerly AIM) or Magellan Healthcare®. You can review how to submit PA or Notification requests and view PA statistical data here.

The requested clinical should be faxed to Medical Management, using the appropriate fax number for the service for which authorization is requested. Medicaid Prior Authorization Fax Numbers: Physical Health: 1-800-690-7030. Behavioral Health: 866-570-7517.

If you have questions, please call Service Coordination toll-free at 1-877-301-4394.

Have your doctor fax in completed forms at 1-877-243-6930.