For a printable PDF of our Provider Quick Reference Guide, please click here.
Customer Service
- Claim inquiry, questions, and information.
- Information about CHIP or STAR products.
- Eligibility/benefits questions on all products.
Phone: 832-828-1004
Toll free: 1-877-213-5508
Telephone TouCHPoint: 832-828-1007
Fax: 832-825-8777
Texas Children’s Health Plan Fraud and Abuse Hotline
Phone: 832-828-1320
Fax: 832-825-8722
Email: FraudandAbuse@TCHP.us
Provider Relations
Inquiries regarding Texas Children’s Health Plan policies and procedures.
- Contract clarification/interpretation.
- Fee schedule inquiries.
- Change of address/phone number/tax identification number.
- Requests for supplies (forms, directories, etc.).
- Information on provider educational in-services.
- Requests for information on accessing Provider TouCHPoint, Texas Children’s Health Plan’s web-based provider portal for claims, authorizations, eligibility, and information.
Phone: 832-828-1004
Toll free: 1-800-731-8527
Fax: 832-825-8750
Website: www.TexasChildrensHealthPlan.org/For-Providers
Email: providerrelations@texaschildrens.org
Texas Children’s Health Plan Pharmacy Information
Navitus website: www.navitus.com
Navitus toll free provider hotline: 1-877-908-6023
Navitus customer care: 1-866-333-2757
Provider Portal
Texas Children’s Health Plan’s new online portal offers you convenient 24-hour access to your patient’s information. Through the Provider Portal, you can view a Texas Children’s Health Plan member’s eligibility, check the status of your claim, submit an authorization, look up an explanation for CPT, diagnosis, or modifier codes, and more.
For a printable PDF of our Provider Portal Training Guide, click here.
For password lockouts: 1-877-814-9909
First-time users, please have your Office Manager complete the online registration form.
Only one registration form is necessary per office.
Cultural Sensitivity
Cultural sensitivity refers to the ability of individuals and systems to provide services effectively to people of all cultures, races, ethnic backgrounds, and religions in a manner that recognizes values, affirms and respects the worth of the individuals, and protects and preserves the dignity of each. Texas Children’s Health Plan’s interpretive services will help to provide care in culturally competent manner.
Texas Children’s Health Plan has a mechanism in place to allow Members with Special Health Care Needs to have direct access to a specialist as appropriate for the Member’s condition and identified needs, such as a standing referral to a specialty physician.
Envolve Vision
- CHIP: 1-844-520-3711
- STAR: 1-844-683-2305
- STAR Kids: 1-844-212-7269
Dental Services
DentaQuest: 1-800-685-9971
MCNA Dental: 1-800-494-6262
Texas Children’s Health Plan value added benefit:
FCL Dental (STAR members over 21): 1-866-548-8123
Care Coordination, Case, and Disease Management
Referrals for assistance with chronic, complex conditions, or maternity. Requests for birthing and health education classes.
Phone: 832-828-1430
Fax: 832-825-8745
Asthma / Obesity / Diabetes education:
Phone: 832-828-1004
Fax: 832-825-8705
Nurse Family Partnership:
Phone: 832-828-1274
Fax: 832-825-8710
Nurse Help Line
Members have access to registered nurses 24 hours a day, 7 days a week.
Texas Children’s Health Plan Nurse Help Line: 1-800-686-3831
Claims Filing Information
Filing deadlines for all products is 95 days from date of service.
Texas Children’s Health Plan Claims
PO Box 300286
Houston, TX 77230-0286
Claims Appeals
All appeals must be received within 120 days from the previous health plan Explanation of Payment (EOP). Please use the appeal coversheet from Texas Children’s Health Plan Provider Manual.
Texas Children’s Health Plan
Attn: Appeals
PO Box 300286
Houston, TX 77230-0286
Prior Authorizations
The prior authorization process is used to evaluate the medical necessity of a procedure, course of treatment, appropriate level of service, and length of stay prior to the provision of services. A copy of the prior authorization request form can be found in the Provider Manual. Prior authorizations should be requested 3 to 5 days prior to the scheduled date of service. Current services requiring authorization are listed below, but please check with Texas Children’s Health Plan Utilization Management at 832-828-1004, option 5 or Provider TouCHPoint at www.tchp.us/providers for updates to this list:
Medical Authorizations
- All genetic testing
- All out-of-network services
- Ambulance services (non-emergent transport)
- Augmentative Communication Devices
- Baclofen injections/pump
- Bariatric Surgery
- Botox Injections
- Chemotherapy non-FDA approved
- Circumcision greater than 1 year of age
- Cochlear Implant
- Contact lenses due to disease process
- Cosmetic Surgery
- Cranial Molding Orthosis (Helmets)
- Dental Medically necessary (except for cleft palate)
- Gait trainer
- Home Health Care
- Hospital grade Blood Pressure Monitors in home use
- Hospital Beds and accessories
- Hospital Inpatient care
- Makena Injections
- Nutritional Supplements
- Oral Surgery
- Organ Acquisition
- PET Scans
- Prescribed Pediatric Extended Care Centers
- Private Duty Nursing in home
- Prosthetics
- Skilled Nursing facility
- SPECT Scans
- Therapy – Physical, Occupational,Speech
- (including initial Eval)
- TMJ diagnosis and treatment
- Transplant Evaluation
- Vision Care, medically necessary
- Wheelchairs and accessories
Behavioral Health Authorizations
- All out-of-network services
- Inpatient Care
- Intensive Outpatient Treatment
- Neuropsychological Testing
- Outpatient Behavior Health visits greater than 30 (per Calendar year)
- Partial Hospitalization
- Psychological Testing (excluding initial eval)
- Residential Treatment Facility
- Targeted Case Management
- Substance Use Disorder Treatment (excluding eval)
Utilization Management
Urgent authorization requests:
Phone: 832-828-1004, option 5
Toll free: 1-877-213-5508
Fax: 832-825-8760
Behavioral Health Authorizations
Members and/or PCPs can self refer to a participating behavioral health provider.
Phone: 832-828-1004, option 5
Toll free: 844-291-7505
Fax: 832-825-8767
Referrals
Patients should be referred to in-network specialists. When Texas Children’s Health Plan members are referred for specialty care to an in-network specialist, it is not necessary to complete a referral form. Members may self-refer for in-network OB/GYN services, behavioral health, family planning, and any Texas Health Steps provider.
Imaging Services
It is not necessary to use a referral form for imaging services. Providers should refer members for imaging services using in-network providers, on an appropriate vendor requisition form. Participating providers, which may vary by product, include:
- Woodlake MRI & Diagnostics
- Universal MRI & Diagnostics
- Any contracted hospital
Laboratory Services
It is not necessary to use a referral form for laboratory services. Providers should refer members for laboratory services to an in-network laboratory, using an appropriate vendor requisition form. Participating providers, which may vary by product, include:
- Quest Laboratories
- Clinical Pathology Laboratory, Inc.
- Any contracted hospital
Phone Numbers for State Programs
- CHIP Help Line: 1-800-647-6558
- Early Childhood Intervention (ECI): 1-800-628-5115
- Family Planning Program: 512-458-7796
- Medicaid Program Member Verification (NAIS): 1-800-925-9126
- Medical Transportation Program (MTP): 1-877-MED-TRIP (633-8747)
- STAR Help Line: 1-800-964-2777
- STARLink Advocate for Medicaid: 1-866-566-8989
- Texas Health Steps: 1-877-847-8377
- Women, Infants & Children Program (WIC): 1-800-942-3678
- Vaccine for Children (VFC): 1-800-252-9152
Behavioral Health Hotline
Members have access to 24/7 crisis assistance
STAR: 800-731-8529
CHIP: 800-731-8528
Provider and Vendor Check Payments (Refunds)
Texas Children's Health Plan
P.O. Box 841976
Dallas, TX 75284-1976
Clinical Practice Guidelines
Available online at www.tchp.us/providers/ or by contacting Provider Relations for a faxed copy.