Provider Initiated Termination Process and Requirements

Date: August 13, 2021 Attention: All Providers Effective Date: December 1, 2020Providers should monitor the Texas Children’s Health Plan (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: Texas Children’s Health Plan (TCHP) would like to inform network providers of the provider initiated termination process and requirements. A provider may terminate from Texas Children’s Health Plan’s network in accordance with the provider’s contract. Termination notifications must be received ninety (90) days prior to the termination effective date. How this impacts providers: Providers may submit their signed Letter of Termination from the signature authority in a number of different ways:

• Letter of Termination sent to providerrelations@texaschildrens.org
• Letter of Termination faxed to 832-825-8750
• Email Letter of Termination to your Provider Relations Representative

The Letter of Termination must include ALL of the following elements in order to process the request timely. If any of the data elements are missing, the Provider Relations Representative will reject the termination request back to the requestor for additional information.

a. Written letter from provider (on letterhead) or group which includes:

b. Provider Name

c. Tax Identification Number (TIN)

d. National Provider Identifier (NPI)

e. Provider Type (PCP or Non-PCP)

f. Type of Termination (Termination from Health Plan/Termination from Provider Group/ or Line Of Business (LOB) such as STAR CHIP or STAR Kids)

g. Termination Reason

h. Termination Effective Date

i. LOB to Term (CHIP, STAR, STAR Kids)

j. Provider Group Name

k. If PCP:

i. PCP Roster Report

ii. New PCP name & NPI to move members to

iii. New Group Affiliation and New Group NPI to move members to

Texas Children’s Health Plan will notify members of the termination and will coordinate care with the provider to ensure continued access to covered services as appropriate. Next steps for providers: Providers should inform their staff of this process. 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.