Your Superior Health Plan Referral

As an Amplifon network provider supporting the Superior HealthPlan contract, all claims for hearing aids and related services for Superior Ambetter, Medicaid, CHIP and Medicare/Medicaid dual eligible members will now be processed by Amplifon as of August 1, 2020.

There are a few unique aspects of the Superior contract that you and your staff should know regarding the process for these members. Further details about each of these requirements can be found below:

• First, all Superior plans supported by Amplifon have a prior authorization element.
• All Superior members must have a medical exam by a physician (ENT preferred) and receive a medical clearance from that physician prior to being evaluated or fit with hearing aids.
• If hearing aids are recommended for the patient, a Physician Order Form must also be obtained and submitted along with the prior authorization request.

1. When a Superior referral is sent to you, you will receive an email from Amplifon with the forms necessary for the prior authorization request. 

• Completed prior authorization forms need to be sent to Amplifon by your office, along with all of the supporting documentation. Amplifon will then submit your documentation to Superior’s Utilization Management team for review.

2. If you will be doing the patient’s audiological evaluation, the following assessments need to be completed (or noted in documentation why it wasn’t completed):

For Patients Under 21

• Conventional or Play Audiometry
• Speech Audimetry
• Otoacoustic Emission (OAE)
• Tympanometry
• Auditory Brainstem Response (ABR)

For Patients 21 and Older

• Pure Tone Audiometry (Air and Bone Conduction Thresholds)
• Speech Recognition Thresholds
• Word Recognition Score
• Tympanometry

If the audiological evaluation was done by another provider, you will need to obtain these results to include with the prior authorization documentation.

3. If hearing aids are being recommended for the patient, submit the following documentation for the prior authorization by uploading to the patient’s record in Amplifon’s provider portal or faxing them to 651-925-0220. The order for the requested device can be entered at this time as well.

• Amplifon Hearing Health Care Prior Authorization Form
• Medical Clearance Form, signed by an MD (ENT physician preferred)*
• Physician Order Form, signed by an MD*
• All hearing assessment documentation, including functional goals and expectations of hearing aid use
  *If your office already has a Medical Clearance and/or Physician Order Form that is used, those will be accepted. Amplifon can provide you with standard forms if you need them.

4. Amplifon will contact your office if additional information is needed and when the prior authorization has been approved. After you are notified of an approved authorization, you can schedule the next appointment for the fitting with the patient.

5. Amplifon will submit all claims to Superior on your behalf, streamlining the process for you and ensuring the best possible outcome for your patient.

6. Once Superior finishes the claims process, Amplifon will issue your reimbursement.

The list of eligible hearing aids for Superior HealthPlan can be found in Sycle.

The price includes the following bundled services: hearing aid(s), fitting fee (V5011), monaural hearing aid dispensing fee (V5200, V5241), or binaural hearing aid dispensing fee (V5110, V5160, V5240).

As standard with other Amplifon plans, Superior HealthPlan members will have access to:

• Risk-free 60-day trial – 100% money-back guarantee if not completely satisfied. No restocking or return fees.
• One year free follow-up care
• Three-year warranty – including coverage for repair, loss or damage**
• Two year supply of free batteries or free charging dock

Batteries

• 2 year free supply of batteries with every purchase (Max 80 cells, per ear per year)
• The first year supply of batteries will be mailed to the patient’s home, along with a reminder letter to contact Amplifon for their second year of free batteries.
• After their two year supply is depleted, the member may contact Amplifon to find out if additional battery coverage is available
• If the patient purchases a rechargeable hearing aid, the charging dock will be included at no additional charge

• Amplifon Hearing Health Care must have a completed W-9 from you in order to process your dispensing fee. 
• You will be paid 60 days after the delivery date. For Medicaid or Dual-Eligible members, reimbursement is $350 per ear. For Ambetter members, Amplifon's standard dispensing fees apply.

If you have any questions regarding our new partnership with Superior Health Plan, don’t hesitate to call Amplifon at 1-800-920-4327.

**Some exclusions apply. Limited to one-time claim for loss and damage. Manufacturer deductibles may apply.