Get Superior Healthplan Star+plus

Completing the SUPERIOR HEALTHPLAN STAR+PLUS outpatient authorization form online is essential for obtaining necessary services. This guide will walk you through each section of the form, ensuring you have the information needed to complete it accurately and efficiently.

Follow the steps to successfully complete the form online.

1. Press the ‘Get Form’ button to obtain the online version of the SUPERIOR HEALTHPLAN STAR+PLUS authorization form.
2. Begin by filling out the member information section. Provide the member ID, date of birth in MMDDYYYY format, and the member's last name followed by their first name.
3. In the requesting provider information section, enter the requesting NPI and TIN numbers, as well as the requesting provider contact name and provider name. Don’t forget to include phone and fax numbers.
4. If applicable, indicate if the servicing provider is the same as the requesting provider. Fill in the servicing NPI and TIN, servicing provider contact name, and provider/facility name.
5. Proceed to the authorization request section. Enter the primary procedure code using CPT or HCPCS, add any additional procedure codes, including modifiers as necessary.
6. Choose the outpatient service type from the list provided, including options for biopharmacy, cardiac pulmonary rehab, and various other outpatient services.
7. Complete the dates section, entering the start date or admission date, the diagnosis code in ICD-9 or ICD-10 format, and the end date or discharge date.
8. Specify the total units, visits, or days required for the service. Ensure that all required fields have been accurately filled, as incomplete forms will be rejected.
9. Before submitting, make sure to attach copies of all supporting clinical information, as lack of this information may delay the determination process.
10. After reviewing the completed form for accuracy, save changes, download, print, or share the authorization request according to your needs.

Complete your SUPERIOR HEALTHPLAN STAR+PLUS authorization form online today for timely service requests.