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Flu Season Alert! Alerta de temporada de influenza:

Don’t let germs win this season – protect yourself and your family!

The flu vaccine is your best defense against flu and related complications – PLUS, it is a covered benefit for Texas Children’s Health Plan members! Learn more!

¡No permitas que los gérmenes ganen esta temporada! ¡Protégete a ti y a tu familia!

La vacuna contra la influenza es tu mejor defensa contra la influenza y sus complicaciones. Además, ¡es un beneficio cubierto para los miembros de Texas Children's Health Plan! Aprende más

External Medical Review

TCHP follows the guidance on External Medical Review in accordance with the Uniform Managed Care Manual, Chapter 3.21.1 and Senate Bill 1207. The resource document available here outlines the different aspects of this process that are completed by designated Independent Review Organizations (IROs) when there are service denials, reductions, and eligibility denials for certain programs based on medical or functional necessity made by TCHP.

TCHP will ensure that all of the appropriate documentation is uploaded in Texas Integrated Eligibility Redesign System (TIERS) that was included in the service reduction or denial decision. Should the Member, the Member’s authorized representative, or the Member’s LAR decide to withdraw the EMR request, they must initiate an EMR request withdrawal communication to us here at TCHP.

External Medical Review contact information:

STAR Members at 832-828-1001 or toll free at 1-866-959-2555
STAR Kids Members toll free at 1-800-659-5764.

For written requests:

Email TCHPUM@TEXASCHILDRENS.ORG
Fax 832-825-8796 

Texas Children’s Health Plan
Attention: Utilization Management Department
WLS 8390
P.O. Box 301011
Houston, TX 77230-1011

Resources: