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.
Call to action: The purpose of this communication is to inform providers and their designated clearinghouse of the custom edits that will go live on July 23, 2025.
How this impacts providers: The Custom edits that will be implemented were active in the legacy Change Healthcare Clearinghouse in February 2024. The edits being re-implemented are as follows.
Billing Taxonomy
Billing Provider taxonomy needs to accompany the Billing Provider NPI.
Service Facility
When place of service is anywhere other than home or office, the facility’s NPI must be present.
NDC
NDCs will be validated against the quarterly NDC Crosswalk to ensure that each NDC is valid and in compliance with the most recent state-provided data. Please note: TCHP will be using the VDP (Vendor Drug Program) quarterly NDC-to-HCPCS Crosswalk.
Billing Provider 2ndry ID
Atypical Provider ID (secondary provider identifier) and qualifier must be in the correct format.
Rendering Physician
Claim must have the correct rendering provider taxonomy and NPI.
Attending Physician
The physician’s first name, last name and NPI are required with the exception of Ambulance and Home Health claims.
Operational Support
Availity Customer Support (ACS) supports providers with all Availity Essentials Portal actions. Provider’s clearinghouse are welcome to contact Availity at 1-800-282-4548 for one of the reasons below. Availity call center is available Monday – Friday, 8am to 8pm EST. Examples include:
Portal registration
User access/ Account assistance
Transaction submissions
Portal error messages
Claim rejection
Texas Children’s Health Plan Call Center supports providers with all ‘data’ related provider inquiries. Providers can contact the Call Center at 832-828-1004 or toll-free at 1-800-731-8527. Examples include:
Claim denial
Benefit coverage details
Prior Authorization details
Claim payment questions
Network details
Next step for Providers: Providers should share this communication with their billing staff and clearinghouse.
