Date: October 19, 2023
Attention: Obstetric Care Providers and Hospitals
Effective date: Informational notice only
Call to action: Texas Children’s Health Plan (TCHP) allows for up to three days prior to a delivery in addition to the federally mandated days after delivery. Admissions resulting in delivery during this time frame do not require a prior authorization. Likewise, inpatient admissions for CHIP Perinate do not require authorization.
How this impacts providers: Inpatient admissions related to spontaneous labor or induction of labor that result in delivery do not require prior authorization for inpatient care and professional services provided that the inpatient admission length of stay is within federal mandate limits of 2 days for vaginal delivery and 4 days for uncomplicated C-section delivery. Antepartum days are allowed up to 3 days before delivery. Any notifications or requests outside of these time frames require clinical documentation and are reviewed for medical necessity. The Prior Authorization form is available here.
Medical Services Fax Line – 832-825-8760 or Toll-Free 1-844-473-6860
Next step for Providers: Providers should reference the TCHP updated Hospital Inpatient Care Guidelines available here.
If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org.
For access to all provider alerts,log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.