Prior Authorization Information | Texas Children's Health Plan
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Prior Authorization Information

Authorizations

 

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

Please contact us if you have questions or need assistance with prior authorizations.
 
Providers: 1-877-213-5508
 
Members:
 
  • CHIP 1-866-959-6555
  • STAR 1-866-959-2555
  • STAR Kids 1-800-659-5764
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

Prior Authorization Guidelines

Below you will find all of the Prior Authorization Guidelines. If you wish to open the following forms, you must have Adobe Acrobat Reader installed on your computer. To download a form, right click on one of the links below and select "Save Target As."
 
Download a free copy of Adobe Acrobat Reader, click here.
 

Augmentative Communication Device Guideline

Bariatric Surgery Guidelines

Behavioral Health Level of Care TCHP Guideline

Botulinum Toxin Guidelines

Circumcision Guidelines

Cosmetic Surgery Guidelines

Cranial Molding Orthosis Guidelines

Gait Trainers and Standers Guidelines

General Anesthesia for Dental Procedures in Members 6 years old and Younger

Genetic Testing Guidelines

Home Health Guidelines

Hospital Bed Guidelines

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

Oral Surgery Guidelines

Out of Network Services Guideline

Outpatient Psychotherapy Visits Greater than 30 per Calendar Year

PDN Guidelines

PET Scan Guidelines

Physical Therapy Guidelines

Progesterone Therapy Guidelines

Prosthetics Guidelines

Psychological/Neuropsychological Testing Guidelines

Skilled Nursing Facility Guidelines

Skills Training Request for CHIP Members Guideline

SPECT Scan Guidelines

Speech Therapy Guidelines

Targeted Case Management & Mental Health Rehabilitation Guideline

Temporomandibular Joint (TMJ) Guidelines

Therapeutic and Reconstructive Breast Procedures Guideline

Wheelchairs Guidelines