Upcoming Appointment Availability Secret Shoppers

Date: October 2, 2023

Attention: All Providers

Effective Date: October 2023

Call to action: Texas Children’s Health Plan (TCHP) would like to remind providers of the appointment availability standards. For your awareness, TCHP will conduct a secret shopper approach and call provider offices on their appointment availability starting this month. The surveys will occur on a quarterly basis going forward and TCHP will determine the providers to call at random.

Appointment Availability Standards 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.

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 TCHP to be out of compliance. In addition, providers and staff are responsible for understanding the requirements.

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

References:

• Previous Provider Alert on Appointment Availability Standards

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.