Texas Standard Prior Authorization Request Form compliance grace period has ended

Starting January 1, 2019, the 90-day grace period for compliance with the exclusive use of the Texas Standard Prior Authorization Request Form has ended. From this date forward, providers must use the Texas Standard Prior Authorization Request Form, which can be found at: https://www.texaschildrenshealthplan.org/for-providers. Click on Downloadable Forms on the left-hand side, then click Standard Prior Authorization Form or Behavioral HealthAuthorization Form to download. As a reminder, the following essential information is required to start the authorization process:

• Member Name, Member Date of Birth, and Member Medicaid/CHIP ID
• Requesting Provider’s Name and Requesting Provider’s NPI Number
• Rendering Provider’s Name and Rendering Provider’s NPI Number
• Service Requested CPT code, Number of Units Requested, and Dates of Service Requested

Texas Children’s Health Plan may return an incomplete prior authorization request when the form does not contain all of the essential information listed above and request that the provider resubmit the request with all of the appropriate information included. Processing of the authorization will not begin until all essential information is received.