Effective January 1, 2023: Ambetter Clinician-Administered Drug Prior Authorization Update

Fecha: 02/11/22

Ambetter from Superior HealthPlan requires Prior Authorization (PA) as a condition of payment for many Clinician-Administered Drugs (CADs) provided to Ambetter members. Effective January 1, 2023, the following changes to PA requirements will take effect:

Providers may submit a PA request by:

• Utilizing Superior’s Secure Provider Portal.
  • If you are not currently registered on the portal, registration is quick and simple.
• Faxing an authorization to the Superior HealthPlan Pharmacy Department at 1-800-690-7030.
  • The Biopharmacy Outpatient Prior Authorization Form (J-code products) can be found on Ambetter's Provider Resources webpage.

As a reminder, providers may determine which specific codes require PA by visiting Superior's Pre-Auth Needed Tool and selecting Ambetter.

For questions regarding this information, please contact your dedicated Account Manager or call Provider Services at 1-877-687-1196.