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Quick Reference Guide

For a printable PDF of our Quick Reference Guide, please click here.

Customer Service

  • Claim inquiry, questions, and information.
  • Information about CHIP or STAR products.
  • Eligibility/benefits questions on all products.

Phone: 832-828-1004
Toll free: 1-877-213-5508
Telephone TouCHPoint: 832-828-1007
Fax: 832-825-8777

Texas Children’s Health Plan Fraud and Abuse Hotline

Phone: 832-828-1320
Fax: 832-825-8722
Email: FraudandAbuse@TCHP.us

Provider Relations

Inquiries regarding Texas Children’s Health Plan policies and procedures.

  • Contract clarification/interpretation.
  • Fee schedule inquiries.
  • Change of address/phone number/tax identification number.
  • Requests for supplies (forms, directories, etc.).
  • Information on provider educational in-services.
  • Requests for information on accessing Provider TouCHPoint, Texas Children’s Health Plan’s web-based provider portal for claims, authorizations, eligibility, and information.

Phone: 832-828-1008
Toll free: 1-800-731-8527
Fax: 832-825-8750
Website: www.TexasChildrensHealthPlan.org/For-Providers
Email: tchpprovrel@texaschildrens.org

Texas Children’s Health Plan Pharmacy Information

Navitus website: www.navitus.com
Navitus toll free provider hotline: 1-877-908-6023
Navitus customer care: 1-866-333-2757

Provider TouCHPoint

Texas Children’s Health Plan’s new online portal offers you convenient 24-hour access to your patient’s information. Through Provider TouCHPoint, you can view a Texas Children’s Health Plan member’s eligibility, check the status of your claim, submit an authorization, look up an explanation for CPT, diagnosis, or modifier codes, and more.

For password lockouts: 1-877-814-9909

First-time users, please have your Office Manager complete the online registration form.

Only one registration form is necessary per office.

Vision Services

CHIP and STAR: 1-800-879-6901 (Block Vision)

Dental Services 

DentaQuest: 1-800-685-9971
MCNA Dental: 1-800-494-6262

Texas Children’s Health Plan value added benefit:

FCL Dental (STAR members over 21): 1-866-548-8123

Care Coordination, Case, and Disease Management

Referrals for assistance with chronic, complex conditions, or maternity. Requests for birthing and health education classes.

Phone: 832-828-1430
Fax: 832-825-8745

Asthma/obesity/diabetes education:

Phone: 832-828-1004
Fax: 832-825-8705

Nurse Family Partnership:

Phone: 832-828-1274
Fax: 832-825-8710

Nurse Help Line

Members have access to registered nurses 24 hours a day, 7 days a week.

Texas Children’s Health Plan Nurse Help Line: 1-800-686-3831

Emdeon–EFT Enrollment and Questions

Visit the ePayment website www.emdeon.com/epayment to sign up today.

Emdeon EFT telephone number: 866-506-2830

Electronic Claims Submission

HIPAA-compliant electronic claims filing. Texas Children’s Health Plan does not accept electronic UB92 claims for STAR through Availity.

CHIP

Emdeon and Availity: 76048
Legacy: 76048C

STAR

Emdeon: 75228
Availity: TXCSM
Legacy: 76048M

Claims Filing Information

Filing deadlines for all products is 95 days from date of service.

Texas Children’s Health Plan Claims
PO Box 300286
Houston, TX 77230-0286

Claims Appeals

All appeals must be received within 120 days from the previous health plan Explanation of Payment (EOP). Please use the appeal coversheet from Texas Children’s Health Plan Provider Manual.

Texas Children’s Health Plan
Attn: Appeals
PO Box 300286
Houston, TX 77230-0286

Prior Authorizations

The prior authorization process is used to evaluate the medical necessity of a procedure, course of treatment, appropriate level of service, and length of stay prior to the provision of services. A copy of the prior authorization request form can be found in the Provider Manual. Prior authorizations should be requested 3 to 5 days prior to the scheduled date of service. Current services requiring authorization are listed below, but please check with Texas Children’s Health Plan Utilization Management at 832-828-1004, option 5 or Provider TouCHPoint at www.tchp.us/providers for updates to this list:
  

Medical Authorizations

  1. All genetic testing
  2. All out-of-network services
  3. Ambulance services (non-emergent transport)
  4. Augmentative Communication Devices
  5. Baclofen injections/pump
  6. Bariatric Surgery
  7. Botox Injections
  8. Chemotherapy non-FDA approved
  9. Circumcision greater than 1 year of age
  10. Cochlear Implant
  11. Contact lenses due to disease process
  12. Cosmetic Surgery
  13. Cranial Molding Orthosis (Helmets)
  14. Dental Medically necessary (except for cleft palate)
  15. Gait trainer
  16. Home Health Care
  17. Hospital grade Blood Pressure Monitors in home use
  18. Hospital Beds and accessories
  19. Hospital Inpatient care
  20. Makena Injections
  21. Nutritional Supplements
  22. Oral Surgery
  23. Organ Acquisition
  24. PET Scans
  25. Prescribed Pediatric Extended Care Centers
  26. Private Duty Nursing in home
  27. Prosthetics
  28. Skilled Nursing facility
  29. SPECT Scans
  30. Therapy – Physical, Occupational,Speech
  31. (including initial Eval)
  32. TMJ diagnosis and treatment
  33. Transplant Evaluation
  34. Vision Care, medically necessary
  35. Wheelchairs and accessories
      

  Behavioral Health Authorizations

  1. All out-of-network services
  2. Inpatient Care
  3. Intensive Outpatient Treatment
  4. Neuropsychological Testing
  5. Outpatient Behavior Health visits greater than 30 (per Calendar year)
  6.  Partial Hospitalization
  7. Psychological Testing (excluding initial eval)
  8. Residential Treatment Facility
  9. Targeted Case Management
  10. Substance Use Disorder Treatment (excluding eval) 

      Utilization Management

      Urgent authorization requests:

      Phone: 832-828-1004, option 5
      Toll free: 1-877-213-5508
      Fax: 832-825-8760

      Behavioral Health Authorizations

      Members and/or PCPs can self refer to a participating behavioral health provider.

      Phone: 832-828-1004, option 5
      Toll free: 844-291-7505
      Fax: 832-825-8767

      Referrals

      Patients should be referred to in-network specialists. When Texas Children’s Health Plan members are referred for specialty care to an in-network specialist, it is not necessary to complete a referral form. Members may self-refer for in-network OB/GYN services, behavioral health, family planning, and any Texas Health Steps provider.

      Imaging Services

      It is not necessary to use a referral form for imaging services. Providers should refer members for imaging services using in-network providers, on an appropriate vendor requisition form. Participating providers, which may vary by product, include:

      • Woodlake MRI & Diagnostics
      • Universal MRI & Diagnostics
      • Any contracted hospital

      Laboratory Services

      It is not necessary to use a referral form for laboratory services. Providers should refer members for laboratory services to an in-network laboratory, using an appropriate vendor requisition form. Participating providers, which may vary by product, include:

      • Quest Laboratories
      • Laboratory Corporation of America
      • Clinical Pathology Laboratory, Inc.
      • Any contracted hospital

      Phone Numbers for State Programs

      • CHIP Help Line: 1-800-647-6558
      • Early Childhood Intervention (ECI): 1-800-628-5115
      • Family Planning Program: 512-458-7796
      • Medicaid Program Member Verification (NAIS): 1-800-925-9126
      • Medical Transportation Program (MTP): 1-877-MED-TRIP (633-8747)
      • STAR Help Line: 1-800-964-2777
      • STARLink Advocate for Medicaid: 1-866-566-8989
      • Texas Health Steps: 1-877-847-8377
      • Women, Infants & Children Program (WIC): 1-800-942-3678
      • Vaccine for Children (VFC): 1-800-252-9152

      Behavioral Health Hotline

      Members have access to 24/7 crisis assistance

      STAR: 800-731-8529
      CHIP: 800-731-8528

      Provider and Vendor Check Payments (Refunds)

      Texas Children's Health Plan
      P.O. Box 841976
      Dallas, TX 75284-1976

      Clinical Practice Guidelines

      Available online at www.tchp.us/providers/ or by contacting Provider Relations for a faxed copy.