Superior HealthPlan — Centene's Texas plan and one of the largest Medicaid footprints in the state — administers the THSteps-CCP Autism Services benefit on the TMPPM's criteria; its provider notices point straight at the state manual for diagnosis and clinical rules. Two things make Superior structurally important for ABA intake: its breadth (STAR and STAR Kids across multiple service areas including Bexar, El Paso, Hidalgo, Lubbock, Nueces, MRSA West, and Travis), and its exclusivity — Superior is the only STAR Health plan, so every Texas foster-care child, statewide, routes ABA through Superior.
Superior announced the ABA benefit at its February 2022 launch with prior authorization required for all ABA services — 97151 for the evaluation, then 97153, 97154, 97155, 97156 and 97158 for treatment, with 99366 team meetings payable only against an approved ABA authorization (its September 2026 manual says interdisciplinary team meetings need no authorization of their own) — and its notices defer to the TMPPM for medical-necessity criteria, so the state's 3-year diagnosis recency, 90/90/180 cadence, and 8-hour daily cap all apply unchanged. Requests go through Superior's provider portal, with the plan's Prior Authorization Requirements page as the code-level reference. And the PA posture is stable: Superior's January 1, 2026 PA-removal list touched no Medicaid ABA codes (the Medicaid removals were 36471, A6216, and A6218 only; its one ABA code, 97157, was dropped from PA for Ambetter Marketplace members, not Medicaid), so plan on full PA for the foreseeable future.[2][3][4][1]
If your practice serves children in foster care, Superior is unavoidable: STAR Health is administered by Superior alone, statewide. That makes Superior credentialing and PA fluency a de facto requirement for foster-care ABA anywhere in Texas — and it means intake should treat "foster care" as a routing answer, not just a demographic note. The clinical rules are the same TMPPM baseline; the population's documentation (medical consenters, caseworker involvement) is the added layer to plan for.[3]
Follows the Texas Medicaid rule — Superior's own provider documents that we checked (October 2026) set no change-of-provider rule of their own. A family that moves to a new ABA provider outside the current group needs a new authorization request with all the documentation of an initial evaluation, plus a change-of-therapy-provider letter signed by the responsible adult giving the date therapy ended (or the last date of service) and the names of both providers (TMPPM § 2.3.9). A move to another provider within the same group keeps the same evaluation, plan of care and authorization period. If the child changes health plans, "Health plan prior authorizations do not automatically transfer," but the new MCO must continue an existing authorization it is told about, at the same amount, duration and scope, until the earliest of 90 days, the end of the authorization, or its own new decision (Managed Care Handbook § 2.8).[5][8]
Joining the network: a provider must be enrolled in Texas Medicaid before an MCO can enroll it; "Individual MCOs and DMOs have their own guidelines for contracting providers," and Medicaid enrollment "does not guarantee that an MCO or DMO will contract enroll or credential a particular provider." All Medicaid MCOs credential through the Texas Association of Health Plans' contracted credentialing verification organization (Handbook § 2.2.1). Superior does not publish whether its ABA network is open, so ask its provider relations team.[5][8]
HHSC sets the claim clocks for every Texas Medicaid MCO in its Uniform Managed Care Claims Manual: a provider must file a claim with the MCO "within 95 Days from the date of service," and the MCO must deny a claim it does not receive in that window unless an exception applies (wrong plan, other insurance, newborns, newly enrolled providers). The MCO must tell the provider it "has 120 Days from the date of disposition to appeal the Claim," and must adjudicate an appealed claim within 30 days. Its performance standard is to adjudicate 98 percent of clean claims within 30 days of receipt and 99 percent within 90 days, with every claim finalized within 24 months of the date of service. When another insurer is billed first, the claim “must be refiled and received by the MCO within 95 Days from the date of disposition by the other insurance resource.” HHSC sets no weekly submission cutoff or check-run day; each MCO runs its own payment cycle. The TMPPM Managed Care Handbook repeats the 95-day rule and sends appeals to the MCO first, then to HHSC as a complaint.[10][8][1]
Superior’s September 2026 manual: outpatient provider claims "must be received by Superior within 95 Days from each date of service on the claim," and a rejected (unclean) submission does not satisfy the deadline. “Corrected claims must be sent within 120 Days of the most recent adjudicated date of the claim, as reflected in the Explanation of Payment.”[10][8][1]
The questions that decide whether a family can start with Superior HealthPlan (TX), and what they have to bring. Each maps onto something intake should ask on the first call.
Follows the Texas Medicaid (TMPPM) rule: birth through 20 years of age on the date of service, with eligibility ending the day of the 21st birthday. CHIP members are excluded from the ABA benefit.[5][3]
Follows the Texas Medicaid (TMPPM) rule: the ASD diagnosis must be made or reconfirmed within 3 years of initiation or recertification; past 3 years a comprehensive re-evaluation of ASD symptom severity levels per DSM criteria is required first.[5][3]
Follows the Texas Medicaid (TMPPM) rule: a developmental pediatrician, neurologist, psychiatrist, licensed psychologist, or an interdisciplinary diagnostic team (a physician, PA or NP in consultation with qualified child specialists with autism expertise).[5][3]
Follows the Texas Medicaid (TMPPM) rule: a reliable, valid, standardized diagnostic assessment tool or combination of tools — the manual names the ADOS, ADI-R and CARS as examples. Screening instruments alone (STAT, M-CHAT-R) do not substitute.[5][3]
Follows the Texas Medicaid (TMPPM) rule: a signed, dated prescriber referral for the evaluation, signed within 60 calendar days before or on the anticipated evaluation date; and for treatment a signed, dated referral from a physician or allowed practitioner (MD/DO, PA, NP, or CNS with delegated authority) stating frequency and duration, signed on or before the service start date and no more than 3 months old. Since 4/1/2025 the prescriber signature is no longer required on the CCP PA form for the 90-day extension.[5][3][7]
Follows the Texas Medicaid (TMPPM) rule: synchronous audio-visual only, modifier 95, on 97151, 97155, 97156, 97158 and 99366. One-on-one direct treatment delivered to the child by a behavior technician or LaBA must be in person — telehealth is prohibited for BT/LaBA-delivered direct service.[5][3]
Superior "will respond to complete prior authorization requests within two Business Days for CHIP products, and within three Business Days for non-CHIP products" — three business days for STAR, STAR Kids and STAR Health, the same as the Texas statutory limit for nonhospitalized members (Tex. Gov't Code § 540.0303). "Urgent requests for services to be rendered within 72 hours may be submitted with reason for urgency indicated" and are decided within 72 hours. The clock runs on a complete request: an incomplete one is returned by fax listing what is missing, and "If the documentation/information is not provided within three Business Days from Superior's provider notification … the request may result in an adverse benefit determination." Lead time: "It is recommended that requests be submitted five Business Days prior to the desired start date." The manual lists ABA evaluation, treatment and "subsequent re-certifications" as PA-required but sets no ABA-specific recertification lead time.[1][11][12]
"Federal and state law require Medicaid (STAR/STAR+PLUS/STAR Kids/CHIP) be the payer of last resort." If the child has other insurance, "you must submit your claim to the primary insurance for consideration," then file with Superior attaching "a copy of the EOB, EOP or rejection letter from the other insurance" — without it the claim pends or denies. On authorization Superior is unusually specific: "An authorization is not required if an authorization from the primary insurance carrier indicating approval is received," but "If the other insurance carrier has denied and Superior is being asked to pay as primary for a service that requires an authorization, the provider will be required to request authorization prior to payment with Superior as primary" — so if the commercial plan may deny ABA, get Superior's PA in place before starting. STAR Health (foster care): "Superior does not actively pursue Coordination of Benefits (COB) for STAR Health members."[1][13]
Coverage decides whether Superior HealthPlan (TX) pays. These decide whether the claim survives: how sessions must be staffed and supervised, what may be billed concurrently, the per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.
Follows the Texas Medicaid (TMPPM) rule: the manual sets no numeric ratio of its own, requiring LBAs to directly supervise LaBAs and behavior technicians in accordance with Texas licensure and deferring to the certifying body's minimums — for RBT-credentialed staff the BACB floor of supervision on at least 5% of service hours each month with two face-to-face contacts. Only direct supervision, where the LBA observes the LaBA or BT with the child, is reimbursable (under 97155); indirect supervision is unpaid.[5][3][6]
Follows the Texas Medicaid (TMPPM) rule: concurrent billing is prohibited — Texas Medicaid will not reimburse multiple ABA providers during one session with the child when more than one provider is present. The single exception is when the family and the child receive separate services and the child is not present in the family session. Total authorized hours may be requested under either 97153 or 97155 and billed as the code matching the service actually delivered — not both for the same clock time with the child present.[5][3]
Follows the Texas Medicaid (TMPPM) rule: direct treatment is capped at 8 hours (32 units) per day combined across 97153, 97154, 97155 and 97158; 97151 is capped at 6 hours (24 units) per evaluation and per re-evaluation; group treatment runs 2 to 8 children. TMPPM: “If services billed exceed the limitations outlined in this section, the claim will be denied, and may be appealed,” so the cap is a claim edit as well as an authorization limit. Authorization periods are two consecutive 90-day terms then recertifications of up to 180 days. Superior’s September 2026 manual says its pre-payment code edits draw on “the Medically Unlikely Edit (MUE) table, the National Correct Coding Initiative (NCCI) files” and state policy manuals.[1][5][3]
Follows the Texas Medicaid (TMPPM) rule: rendering ABA providers must sign each entry with full signature and credentials, with additional supervisory signatures per state licensure. Treatment notes carry the child's name, date of service, start and stop times, goals addressed, progress and a summary of interventions; 97155/97158 notes add protocol-modification decision points. The 97151 evaluation and the 90-day progress summary each need a dated signature from the LBA and from the parent or caregiver.[5][3]
Follows the Texas Medicaid (TMPPM) rule: home, clinic, office and community settings are payable. In schools, services delivered by a behavior technician as a shadow, an aide, or as general support are excluded; school personnel participating to coordinate care are not counted as duplicate providers, and interdisciplinary team meetings bill under 99366 against an ABA PA. BT and LaBA direct treatment must be in person in every setting.[5][3]
Follows the Texas Medicaid (TMPPM) rule: only the LBA enrolls in Texas Medicaid and bills. LaBAs and behavior technicians may not enroll — their services go out under the supervising LBA's NPI with the credential modifier identifying who rendered (HO = LBA, HN = LaBA, HM = behavior technician; 97151 takes HO only, 97155/97156/97158 take HO or HN). The LBA must directly employ or contract with every LaBA and BT on the team.[5][3]
Yes — the Texas Medicaid Autism Services benefit on TMPPM criteria, with prior authorization required on every ABA code, evaluation included, through Superior's provider portal.
No — Superior explicitly points providers to the TMPPM for diagnosis and clinical criteria and mirrors the state PA code list. What's Superior-specific is the portal, the PA-list mechanics, and the STAR Health foster-care line.
STAR Health, the Texas Medicaid program for children in foster care, is administered statewide by Superior alone — every foster-care ABA case routes through it.
A new ABA provider outside the current group must file a new authorization with initial-evaluation documentation and a change-of-provider letter signed by the responsible adult (TMPPM § 2.3.9). A new health plan must continue an existing authorization for up to 90 days, or until it ends or the new plan decides.
It does not publish an open or closed status. Enroll in Texas Medicaid first, then apply to the plan; Medicaid enrollment does not guarantee an MCO contract. Ask provider relations.
Ninety-five days from the date of service. HHSC’s Uniform Managed Care Claims Manual sets it for every Texas Medicaid MCO, and Superior’s own manual states the same deadline. Claim appeals get 120 days from the disposition date.
HHSC requires every Texas Medicaid MCO to adjudicate 98 percent of clean claims within 30 days of receipt and 99 percent within 90 days.
Payer policies change frequently and vary by plan, state, and funding type. This guide was compiled from the sources above and last reviewed October 2026; it is general information, not billing, legal, or clinical advice. Always verify current requirements against the payer's live policy and a benefits check for the specific member.
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