The Vendor Drug Program (VDP) made changes to the Texas Medicaid drug formulary effective January 30, 2026. To learn more about formulary changes impacted, please click here for more information
COVID Flexibility, Waiver of Prior Authorization Requirements for out-of -network PCP Visits
Date: December 23, 2024
Attention: Primary Care Providers, Family Practice, General Practice, Internal Medicine, OG/GYN
Effective date: March 22, 2025
Call to action: This communication is to serve as notice that Texas Children’s Health Plan (TCHP) will change the prior authorization (PA) requirements for out-of-network (OON) primary care provider (PCP) visits. Effective for dates of service on or after December 31, 2024 a prior authorization will be required for OON PCP visits.
If a member would like to find an in-network provider, please direct them to our online “Find a Provider” directory available here, https://www.texaschildrenshealthplan.org/find-a-provider.
Member Services can be contacted for further assistance:
- CHIP: 832-828-1002 (local), 1-866-959-6555, TTY 800-735-2989 (Texas Relay) or 7-1-1
- STAR: 832-828-1001 (local), 1-866-959-2555, TTY 800-735-2989 (Texas Relay) or 7-1-1
- STAR Kids: 832-828-1003 (local), 1-800-659-5764, TTY 800-735-2989 (Texas Relay) or 7-1-1
- STAR Kids members can reach their service coordinator 800-659-5764.
The hours are 8 a.m. to 5 p.m. CST, Monday through Friday.
Background information: TCHP continued this COVID flexibility of not requiring a PA beyond the Health and Human Services time frame of May 11, 2023, however must discontinue the flexibility on December 31, 2024.
Next step for Providers: At the time of scheduling an appointment, providers should verify that their patient is an active TCHP Member. Or secure a prior authorization before the appointment date.
If you have any questions, please email Provider Relations at:providerrelations@texaschildrens.org.
For access to all provider alerts: https://www.texaschildrenshealthplan.org/providers/provider-news/provider-alerts.