Retracted: Coordination of Benefits for Utilization Management Update

Date: April 19, 2023

Attention: All Providers

Call to action:  As you may remember, Texas Children’s Health Plan (TCHP) previously communicated changes to our Coordination of Benefits Procedure on February 15, 2023. After careful consideration and listening to your concerns, the Utilization Management (UM) team has decided to pause on any changes and revert back to the original procedure. A link to the former procedure that is currently being followed is available here.

How this impacts providers: Providers that received a rejection letter due to coordination of benefits are advised to resubmit the authorization request for processing. UM will reinstate authorizations for members that had previously denied due to a coordination of benefits reason. This will allow time for UM to validate the claims scenarios and ensure accuracy of claims processing. Once validation is completed, TCHP will decide if any edits are required to improve the Coordination of Benefits Procedure and properly communicate these to the impacted providers. 

Next steps for providers: Providers should share this communication with their staff.

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.