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What Is Needed on an H2067 Form?

Date: 05/24/16

As part of Superior’s continued efforts to improve Superior’s authorization process and expedite the turn-around time for completing and submitting STAR+PLUS long-term services and supports (LTSS) authorizations, Superior would like to request that LTSS providers include NPI and TIN ID numbers on every H2067 form submitted to Superior.

Including these two identifiers on the form will allow Superior Service Coordinators and Program Coordinators to process authorizations quickly and efficiently, as well as easily identify the provider for each submission. For providers, this will significantly reduce the turn-around time for your authorizations.

For any questions, please contact Superior’s Service Coordination department at 1-877-277-9772.

To download a H2067 form, please visit https://www.dads.state.tx.us/forms/2067/
.