COVID-19 Disaster Declaration – Prior Authorization Adjustments

Attention: All ProvidersEffective Date: March 18, 2020TCHP affiliated providers should monitor the TCHP Provider Portal regularly for alerts and updates associated to the COVID-19 event. TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event. Call to action:As are result of the COVID-19 Disaster Declaration, TCHP has instituted the following:

In order to increase access to primary care services, TCHP is now waiving prior authorization requirements for out-of-network primary care visits (Pediatrician, Family Practice/General Practice, Internal Medicine, OB/Gyn) an authorization will not be needed for these services while the COVID-19 State of Disaster Declaration is in place. When the service requested by a Primary Care Provider requires authorization, the service should be reviewed for medical necessity (e.g. genetic testing) as part of the authorization process

Authorizations requested by out-of-network (OON) providers for other services may be approved when the member is unable to access in-network services during the COVID-19 State of

LTSS service authorizations expiring in March will be extended for 120 days and those expiring in April will be extended for 90 days.

TCHP will approve extensions of existing authorizations for services when the provider states that the member was unable to access services while the COVID-19 State of Disaster is in place. Authorization extension can be given 30 days at a time.

For LTSS, PDN, therapy, and DME services, TCHP may waive the “change of provider” letter requirements and approve changes of a previously approved or authorized provider at the provider/member request without formal documentation. Providers/members should state “Need to Change Provider, COVID-19” in the request.

We will temporarily waive hearing screen and well-child requirements for therapy approvals for services that start during the COVID-19 State of Disaster Declaration or for extension requests that are requested during this time.

How this impacts providers:

This means a claim for out-of-network (OON) PCP office visits (see the above listed provider types) will pay during the COVID-19 Disaster Declaration.

Certain authorizations as stated above will be waived, relaxed or granted automatic extension.

In cases where authorization extensions are granted Provider should expect to receive a notice of extension

Certain supportive diagnostics and testing will be waived as stated above.

Next steps for providers:

If your request involves a “change of provider,” you must ensure your request includes the following message “Need to Change Provider, COVID-19.” TCHP staff will contact you if further information is needed to process the change request.

If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.For access to all provider alerts,log into: www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.