No PA Needed for Value Based Provider Network

Date: 03/17/17

Superior Primary Care Providers (PCPs) that serve STAR, STAR+PLUS, STAR Health, STAR Kids and CHIP members now have the option to refer members requiring initial evaluations and re-evaluations for therapy without obtaining prior authorization. To do so, the PCP must refer the member to a therapy provider in Superior’s Value-Based Therapy Provider Network. Value-based providers meet Superior’s quality, cost and length-of-stay measures.

The following providers have received a value-based status for speech, occupational and/or physical therapy as of June 8, 2016. If a member needs to be evaluated for speech, occupational and/or physical therapy and is referred to these providers, no prior authorization is required for the initial evaluation or re-evaluation. If therapy services are deemed necessary after an evaluation, the value-based therapy provider will be responsible for submitting the prior authorization request.

BEXAR Service Delivery Area: PHYSICAL THERAPY* Momentum Physical Therapy and Sports Rehab
Clinics	Address	City	Zip	Phone	Fax
281 & Evans	20821 US Hwy 281 North, #110	San Antonio	78258	1-210-610-4480	1-210-334-0948
Bandera	3456 Hwy 16 South	Bandera	78003	1-830-796-3447	1-830-796-3685
City Base West	7003 S. New Braunfels Ave., #114	San Antonio	78223	1-210-892-0359	1-210-253-9535
Floresville	2004 10^th St.	Floresville	78114	1-830-393-8800	1-830-393-8828
Helotes	12952 Bandera Rd., # 107	Helotes	78023	1-210-372-9600	1-210-372-9923
La Vernia	13857 US Hwy 87 West, Ste. #400	La Vernia	78121	1-830-253-2101	1-830-779-2056
Live Oak	7909 Pat Booker Rd.	San Antonio	78233	1-210-653-2400	1-210-653-2422
Medical Center	5441 Babcock Rd., #103	San Antonio	78240	1-210-253-3888	1-210-253-3889
Westcreek	11219 Potranco Rd., Bldg. A, #110	San Antonio	78253	1-210-679-6900	1-210-679-6904
Westover Hills	10555 Culebra Rd., #103	San Antonio	78251	1-210-888-6042	1-210-888-6045
USAA	9800 Fredericksburg Rd.	San Antonio	78288	1-210-696-8690	1-210-694-0756

HIDALGO Service Delivery Area: SPEECH, OCCUPATIONAL & PHYSICAL THERAPY
Clinics	Address	City	Zip	Phone	Fax
Best Care Physical Therapy	4716 S. Jackson Road	Edinburg	78539	1-956-618-1300	1-956-618-1385
Best Care Physical Therapy	421 S. 12^th Street	McAllen	78501	1-956-800-5620	1-956-800-5621
Milestones Therapeutic Associates	7007 N. 10^th Street	McAllen	78504	1-956-217-0330	1-956-661-0482
Total Rehabilitation	595 W. Sesame Dr.	Harlingen	78850	1-956-428-5440	1-956-428-3375
Total Rehabilitation	4430 E. 14^th Street, Unit E	Brownsville	78521	1-956-542-2845	1-956-548-9019
Institutue of Child Health Services	595 W. Sesame Dr.	Harlingen	78850	1-956-230-1605	1-956-428-3375
Institue of Child Health Services	4430 E. 14^th Street, Unit E	Brownsville	78521	1-956-542-6296	1-956-548-9019

If you do not choose to refer to the value-based providers, your request is subject to standard prior authorization requirements. For more information on Superior’s prior authorization requirements, please refer to the provider manual located at https://www.SuperiorHealthPlan.com/providers/training-manuals.html.

For any questions, please reach out to the Superior Provider Programs department at SuperiorProviderPrograms@SuperiorHealthPlan.com.

*Note: Superior will notify providers if the value-based provider expands their therapy practice to include additional services.