Reminder: Prior Authorization Form Completion

Date: February 13, 2024

Attention: All Providers

Call to action: Texas Children’s Health Plan (TCHP) supports the guidance from Texas Health and Human Services Commission (HHSC) on rejecting the Prior Authorization (PA) received with incomplete or insufficient documentation per Uniform Managed Care Manual (UMCM), Chapter 3.22.

‘Essential Information’ is the information required to initiate the PA review process, and are as follows:

• Member name
• Member number or Medicaid number
• Member date of birth
• Requesting provider name
• Requesting provider’s National Provider Identifier (NPI)
• Service requested – Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), or Current Dental Terminology (CDT)
• Service requested start and end date(s)
• Quantity of service units requested based on the CPT, HCPCS, or CDT requested

How this impacts providers: PA requests submitted without Essential Information will be rejected until the correct information is provided.

Additionally, TCHP would like to remind providers that they can submit Prior Authorizations securely online via Texas Children’s® Link, our online provider portal. Providers are encouraged to submit authorization requests on our portal since this is the most efficient way for our team to process authorizations. To access Texas Children’s® Link, click here.

Next steps for providers: Please ensure that each PA form submitted has Essential Information documented to avoid delays in processing

Resources:

• Standard Prior Authorization Form
• Prior Authorization Information on our website

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.