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.
Provider Offices Are Eligible for Incentive with Completion of Appointment Accessibility Survey
Date: May 8, 2023
Attention: Primary Care and Specialist Providers
Launch timeframe: Summer 2023
Call to action: Texas Children’s Health Plan (TCHP) is excited to launch our annual Provider Appointment Accessibility this summer- this time with a new feature. Providers that complete the survey will be entered into a gift card drawing*. Winning practices will be contacted at the conclusion of the survey.
Background information: In 2015, Senate Bill 760 passed, requiring Texas Health and Human Services Commission (HHSC) to monitor the provider networks of managed care organizations. TCHP would like to ensure members are able to schedule appointments with providers in accordance with the HHSC’s appointment accessibility guidelines. To accomplish this, we have partnered with SPH Analytics to conduct an appointment accessibility survey during this summer to verify that network providers meet the required standards.
How this impacts providers: TCHP enforces access and other network standards required by the contract and takes appropriate action with providers whose performance is determined by the health plan to be out of compliance. In addition, providers and staff are responsible for understanding the requirements.
*Please note, not all provider offices are surveyed. It is a random sample chosen by SPH Analytics.
Authorization reminder: Primary Care Providers, a reminder that a referral is not needed to see an
in-network specialist.
Appointment availability standards
PROVIDER TYPE
LEVEL/TYPE OF CARE
APPOINTMENT AVAILABILITY STANDARDS
OB/GYN
Emergency services
Immediately
Urgent condition
Within 24 hours
Initial appointment for prenatal care
14 days
Initial prenatal care appointments for high-risk pregnancies or new members in third trimester (≥24 weeks)
Initial appointment must be offered within 5 days, or immediately, if emergency exists
Appointments for ongoing OB care must be available in accordance to treatment plan as developed by the provider
Must be available in accordance to the treatment plan as developed by the provider
PRIMARY CARE
Emergency services
Immediately
PHYSICIANS
Urgent condition
Must be provided within 24 hours
Primary routine care
Within 14 days
Preventive health services for Members 21 years of age or older
Within 90 calendar days
Preventive health services for members less than 6 months of age
Offered as soon as possible but no later than 14 days of enrollment for newborns
Preventive health services for members 6 months through age 20
Must be provided within 60 days
New members 20 years of age or younger to receive a Texas Health Steps checkup
Within 90 days of enrollment
CHIP Members should receive preventive care in accordance with American Academy of Pediatrics (AAP)
AAP Periodicity Schedule
SPECIALTY CARE
Emergency services
Immediately
Urgent condition
Must be provided within 24 hours
Specialty routine care
21 days
BEHAVIORAL
Emergency services
Immediately
HEALTH
Urgent condition
Within 24 hours
Care for non-life threatening emergency
Within 6 hours*
Initial visit for routine care
Within 14 days*
Follow-up routine care
Within 90 days*
Initial outpatient behavioral health visit (Does not apply to CHIP Perinate members)
Within 14 days
Initial outpatient treatment after inpatient discharge
Next steps for providers: Providers should share the appointment availability standards with their staff and implement internal procedures for compliance, if needed.