Superior HealthPlan

Welcome to the Superior HealthPlan page.  The documents below have been designed to help RadMD users navigate the prior authorization process for each program Evolent is responsible for. Additional process-specific training tools and modules can be found via links on the Resources tab at the top of the screen.

Effective January 1, 2026, Superior HealthPlan is adding Integrated Dual-Eligible Special Needs Plans (D-SNP) to their current programs with Evolent.

If you have any questions about our programs, please contact your dedicated Evolent Provider Engagement Manager:

• Priscilla Singleton (Advanced Imaging/Cardiology)
• Karla Lowery (Interventional Pain Management/Musculoskeletal/Physical Medicine)
• Charlotte Taylor (Genetic Testing)

SUPERIOR HEALTHPLAN (MEDICAID): Effective 10/06/2025, therapy requests must include either a completed Texas Medicaid PT/OT/ST Prior Authorization Form signed/dated by the referring physician, OR a signed/dated physician order, as well as a Plan of Care signed/dated by the referring physician. In lieu of having the Plan of Care signed, a physician's referral or order dated on or after the evaluation (or re-evaluation) that specifies frequency and duration of services acceptable.

MEDICARE plans: Effective 8/5/2024, peer-to-peer discussions must be performed before a final determination has been made on the request. Medicare re-opens are only allowed if the request complies with the CMS definition of a re-open. Providers will continue to have the option to submit an appeal utilizing the health plan’s process. 

Peer-to-Peer Process  

For access to our peer-to-peer process, click here.

Conservative Treatment Forms  

For access to our conservative treatment forms, click here.