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.
Essential Information for Prior Authorization Submission
Date: January 13, 2021
Attention: All Providers
Providers 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 remind network providers of the required information for a prior authorization submission.
The Texas Standard Prior Authorization Form* including the following information:
Member Name
Member Date of Birth
Member Medicaid/CHIP Identification Number
Requesting Provider Name and National Provider Identifier (NPI)
Servicing Provider Name and NPI
Requested Service
Current Procedures Terminology (CPT) Codes Requested
Number of Units Requested
Dates of Service
*Standard Prior Authorization Form
An in-network provider signature is no longer required on the authorization form.
How this impacts providers: When Texas Children’s Health Plan (TCHP) receives a request for prior authorization for a Medicaid member under age 21, and the request does not contain complete documentation and/or information TCHP will do the following:
Return the request to the Medicaid provider with a letter describing the documentation that needs to be
submitted, and
When possible, TCHP will contact the Medicaid provider by telephone and obtain the information necessary to complete the prior authorization process.
If the documentation/information is not provided within sixteen (16) business hours of TCHP’s request to the Medicaid provider, TCHP will send a letter to the member explaining that the request cannot be acted upon until the documentation/information is provided. Additionally, a copy of the letter is sent to the Medicaid provider describing the documentation/information that needs to be submitted.
If the documentation/information is not provided to the TCHP within seven calendar days (7) of its letter to the member, TCHP will send a notice to the member informing the member of its denial of the requested service due to the incomplete documentation/information. At this time, the member has an opportunity to request an appeal through the TCHP’s internal appeals process and the Health and Human Services Commission state fair hearing process.
