Wednesday, July 24, 2024

Superior Medicaid Prior Auth. Problems

Tyler Flavin

To anyone working with Superior Medicaid regularly,

We received a letter from Superior Medicaid stating that there is a
“temporary relaxation of prior authorization requirements for DMEPOS”
between the dates of July 15, 2021 and October 31, 2021.

Unfortunately, Superior has not held up their end of the deal and we have
dozens and dozens of claims pending right now. These are the two scenarios
we have run into:

1. We submit a claim without prior authorization.
The claim is then denied due to lack of prior authorization.

2. We submit a claim requesting prior authorization.
Superior will not process the claim and cite that prior
authorization is not required.

Both routes result in a denial on the base codes and majority of codes.

Has anyone else experienced this? If anyone has any helpful information,
let me know.

Thank you,
Tyler Flavin CPO/LO
Phone: 210-692-1111

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