Authorizations
- Standard Prior Authorization Form
- Prior Authorization Requirements
- Prior Authorization Reference Information
- Prior Authorization Update Summary
- Prior Authorization Guidelines Annual Review Summary
- Authorization Process Required Information
Prior Authorization Fax Lines
- Medical Services Fax Line - 832-825-8760 or Toll-Free 1-844-473-6860
- Behavioral Health Services Fax Line - 832-825-8767 or Toll-Free 1-844-291-7505
- LTSS and Private duty Nursing Fax Line - 346-232-4757 or Toll-Free 1-844-248-1567
Contact Us
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CHIP 1-866-959-6555
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STAR 1-866-959-2555
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STAR Kids 1-800-659-5764
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 |
Prior Authorization Guidelines
Augmentative Communication Device Guideline
Behavioral Health Level of Care TCHP Guideline
Cranial Molding Orthosis Guidelines
Gait Trainers and Standers Guidelines
General Anesthesia for Dental Procedures in Members 6 years old and Younger
Hospital Grade Blood Pressure Device Guidelines
Hospital Inpatient Care Guidelines
Implantable Hearing Device Guideline
Level of Care, Behavioral Health
Magnetoencephalography Guidelines
Miscellaneous DME (E1399) when billed amount exceeds $500
NIPT - Genetic Testing Guidelines
Nutritional Supplements Guideline
Occupational Therapy Guidelines
Out of Network Services Guideline
Outpatient Psychotherapy Visits Greater than 30 per Calendar Year
Progesterone Therapy Guidelines
Psychological/Neuropsychological Testing Guidelines
Skilled Nursing Facility Guidelines
Skills Training Request for CHIP Members Guideline
Targeted Case Management & Mental Health Rehabilitation Guideline
Temporomandibular Joint (TMJ) Guidelines
Therapeutic and Reconstructive Breast Procedures Guideline