Ambetter from Superior HealthPlan

Source: https://www.ambetterhealth.com/content/dam/centene/Superior/Ambetter/PDFs/TX-MbrReimbursMedicalClaim.pdf

Read date: 10-09-2026

Research steps

1. Complete the current fillable 2025-2026 Member Reimbursement Medical Claim Form, one family member and provider per form and no more than one month of reimbursement requests per form. https://www.ambetterhealth.com/content/dam/centene/Superior/Ambetter/PDFs/TX-MbrReimbursMedicalClaim.pdf
2. Add proof of services, itemized proof of payment, and an itemized service list. Complete all provider, diagnosis, procedure, date, treatment-setting, and amount-paid fields and sign the member certification. https://www.ambetterhealth.com/content/dam/centene/Superior/Ambetter/PDFs/TX-MbrReimbursMedicalClaim.pdf
3. Portal upload is NO. The 2026 EPO and HMO transparency notices publish a nonportal submission route and do not publish a portal or app claim-upload path. No address or fax route is recorded here. https://www.ambetterhealth.com/en/tx/resources/handbooks-forms/transparency-notice-2026/
4. Resolve the published deadline conflict against the member's controlling plan: the current form says within one year, while both 2026 transparency notices say notice within 30 days and receipt of the claim within 90 days. https://www.ambetterhealth.com/en/tx/resources/handbooks-forms/2026-transparency-notice-tx-hmo/
5. Reimbursement is sent to the Plan subscriber. The form says most complete requests take 30 days, while its checklist says 45 days. https://www.ambetterhealth.com/content/dam/centene/Superior/Ambetter/PDFs/TX-MbrReimbursMedicalClaim.pdf
6. Check status in the Online Member Account: Activity & Usage, Filter/Search Claims, expand the claim, then select View explanation of benefits. https://www.ambetterhealth.com/content/dam/centene/Superior/Ambetter/PDFs/AMB-TX-2025-OMA-Claim-EOB-Search-Member.pdf

Filing facts

• Portal upload: NO
• Portal: Ambetter Online Member Account, status only
• Portal path: No claim upload path is published. The 2026 EPO and HMO notices direct the reimbursement form and detailed bill to a nonportal route
• Mail address: Ambetter from Superior HealthPlan, Claims Department-Member Reimbursement, P.O. Box 5010, Farmington, MO 63640-5010
• Fax: NOT PUBLISHED
• Attach: completed signed reimbursement form; proof of services; itemized proof of payment; itemized list of services; subscriber and patient identifiers; provider name, address, NPI, tax ID, telephone, organization or group information; treatment setting; illness or injury explanation; diagnosis code and description; date of service; procedure code and description; amount paid
• File types: NOT APPLICABLE
• File size limit: NOT APPLICABLE
• Maximum files: NOT APPLICABLE
• One file or separate files: NOT APPLICABLE
• Confirmation: Written receipt and acceptance or rejection notices are published for the nonportal route
• Status check: Online Member Account > Activity & Usage > Filter/Search Claims > expand claim > View explanation of benefits
• Processing time: Current form says 30 days, its checklist says 45 days; 2026 plan notices publish 15-day receipt and investigation, 15 days after complete information for acceptance or rejection, and up to 45 days after delay notice for paper claims
• Member deadline: Current form: within one year from date of service; 2026 EPO and HMO notices: notice within 30 days and receipt of claim within 90 days
• Deadline basis: YES: the current form and 2026 plan notices conflict, so the controlling EPO or HMO policy and member document govern
• Mental health route: The same medical reimbursement form discusses medical and behavioral emergency care; no separate behavioral member claim route is published

Confirm the address, fax number or portal path on the insurer's own claims page before you send; read on 10-09-2026.