Texas Children's Health Plan will be closed on Monday, September 1st, in observance of Labor Day. In our absence, you can reach our after-hours nurse help line at 1-800-686-3831. We will resume normal business hours on Tuesday, September 2nd. Wishing you a safe and happy Labor Day!
Texas Children's Health Plan estará cerrado el lunes 1 de septiembre por el Día del Trabajo. Durante nuestra ausencia, puedes comunicarse con nuestra línea telefónica de ayuda fuera del horario habitual al 1-800-686-3831. Reanudaremos nuestro horario regular el martes 2 de septiembre. ¡Te deseamos un feliz y seguro Día del Trabajo!
New Rewards Coming Soon!¡Se vienen nuevas recompensas!
Our Healthy Rewards Program is getting an update in September! For a sneak peek of all the changes - including new rewards and ways to redeem them - please click here.
¡Nuestro Programa Healthy Rewards tendrá su actualización en septiembre! Para ver un adelanto de todos los cambios, incluyendo nuevas recompensas y formas de canjearlas, haz clic aquí.
Reminder of mailing address and procedure for overpayments
Attention: All Providers Effective Date: March 20, 2020
Should a provider receive an overpayment from Texas Children’s Health Plan they should immediately take the following action. A provider has an obligation to notify Texas Children’s
Health Plan in writing upon identification of an overpayment, no more than thirty (30) days from the date of discovery. The overpayment can be remediated through refund to Texas Children’s Health Plan, or a provider may request a recoupment from future claim payments.
For refunds:
If a provider wishes to refund the overpayment by issuing a check to Texas Children’s Health Plan, the refund check must be submitted within thirty (30) days of notification of the overpayment, or sixty (60) days from the date of the discovery of the overpayment, whichever is less. If a refund check is not received within that timeframe, Texas Children’s Health Plan will proceed with recoupment of the overpayment(s). Do not mail letters, correspondence, or other documentation that does not contain a check payment to the address below. This address is only for check payments. To submit a refund check, a provider should mail the check and the supporting documentation to:
Texas Children’s Health Plan
P.O. Box 841976
Dallas, TX 75284-1976
Supporting documentation:
Provider name
Tax identification number and NPI
Refund amount for each claim and claim number
Member name and ID number
In the case of incorrect coordination of benefits, the primary carrier’s explanation of benefits statement.
Reason for refund or recoupment
Any other documentation, which would assist in accurate crediting of the refund.
For recoupments:
If a provider requests Texas Children’s Health Plan recoups the overpayment, the prior erroneous payment(s) will be reversed within thirty (30) to sixty (60) days of receipt of the request. When the
overpayment is recouped, the reversal of the prior payment will be reflected on the provider’s Explanation of Payment (EOP) after the claim is adjusted and the monies that were paid prior will be deducted from the net amount due for claim payments as documented on the current EOP. To submit a request to recoup an overpayment, a provider should mail the written request and supporting documentation to:
Texas Children’s Health Plan
Attention: Claims Administration Refund Department
P.O. Box 300286
Houston, TX 77230-0286
Next steps for providers: Providers should follow the outlined procedure and timeline for notification.
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.
