Prior Authorization | Texas Children's Health Plan

Attention Members!

COVID-19 Information

If you feel you or your loved ones have been exposed to the Coronavirus (COVID-19), please do one of the following:

Call your Primary Care Provider directly
See an online provider now through Texas Children’s Anywhere Care with a smartphone, tablet, or computer. The online visits are a covered benefit for Texas Children’s Health Plan members.
Call our 24 hour nurse help line at 1-800-686-3831 or TDD 1-800-735-2989
COVID-19 Fraud Alert

Please contact Texas Children’s Health Plan if you have questions or need help with prior authorizations.

Utilization Management Hours of Operation:

Monday through Friday 8 a.m. to 6 p.m. CST

Members:

CHIP 1-866-959-6555
STAR 1-866-959-2555
STAR Kids 1-800-659-5764

Providers:

1-800-731-8527

Texas Children’s Health Plan offers TDD.TTY services for deaf, hard of hearing or speech impaired members and providers. For TDD assistance, please call 1-800-735-2989 or 7-1-1.

Prior Authorization Determinations

The Utilization Management department processes service requests in accordance with the clinical immediacy of the requested services.

Authorization | Turnaround Time

Routine | Within 3 business days after receipt of request

Urgent | Within 1 business day after receipt of request

Inpatient | Within 1 business day after receipt of request

Life-threatening conditions | Within one hour

TCHP does not require prior authorization for Emergency Medical Conditions or Emergency Behavioral Health Conditions

Post hospital discharge services | Within one business day

Member Services Contact Information with Hours of Operation and Schedule

Feel free to contact our Member Services Department with any questions you may have. Texas Children’s Health Plan wants to keep your family happy and healthy. Our Member Services team is ready to take your call from 8 a.m. to 5 p.m., Monday through Friday. After hours, on weekends and holidays, our answering service is ready to help you and/or take your messages. A Member Service Representative will return your call the next business day.

We speak English or Spanish. We also have interpreters available by phone who speak 140 different languages.

Emergency Service and Behavioral Health services are available 24 hours a day, 7 days a week.

By Mail:

Texas Children’s Health Plan
PO Box 301011, WLS-8360
Houston, TX 77230-1011

Have us contact you:

One of our representatives will contact you within 2 hours or within one business day for calls received on nights, weekends and holidays.