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Prior authorization process change effective July 1, 2025

Superior HealthPlan has partnered with Evolent to oversee utilization review for interventional cardiology services.

Effective for service dates July 1, 2025 and after, prior authorization must be requested through Evolent for applicable non-emergent, cardiology services for Superior HealthPlan Medicaid (STAR, STAR Health, STAR+PLUS), STAR+PLUS Medicare-Medicaid Plan (MMP) and Wellcare By Allwell Medicare members aged 21 and older, and Ambetter from Superior HealthPlan members aged 18 and older.

Interventional cardiology services will require prior authorization through Evolent prior to being rendered in a provider’s office, outpatient hospital, ambulatory, or inpatient setting (planned professional services only). Evolent uses clinical criteria based on nationally recognized guidelines to promote evidence-based practices.

Authorizations issued prior to this transition remain in effect until the validity period end date or expiration date. Upon expiration, a new authorization will be required from Evolent for services rendered on and after July 1, 2025.

Providers may begin contacting Evolent on June 24, 2025, to seek prior authorization for interventional cardiology services scheduled for dates of service on or after July 1, 2025.

What does this mean for you?

The Evolent program will apply to all specialties for the following non-emergent interventional cardiology services:

• Cardiac catheterization and intervention
• Electrophysiology
• Vascular radiology and intervention
• Cardiac surgery
• Vascular surgery

Prior authorization requests can be submitted to Evolent:

• Via the Evolent Provider Portal
• Via telephone at 1.800.642.7554 (Monday - Friday from 7:00 a.m. to 7:00 p.m. CST)