Private Duty Nursing Services Reminder
Thank you for your continued partnership and the care you provide to our members. Texas Children's Health Plan (TCHP) would like to remind you of the contractual obligations as a network provider with TCHP to provide the authorized hours of PDN services to each member under your care. When unforeseen circumstances occur, TCHP must be notified immediately when a PDN commitment is unfulfilled and a member will be left unattended so that we can help arrange for an alternative provider, if necessary. Your points of contact are:
TCHP’s Provider Relations Department must be contacted. Providers can reach the Provider Relations Department at email@example.com or 1-800-731-8527.
The member’s Primary Care Physician (PCP) or authorizing physician should also be notified. If you are unsure of the PCP, please call our Care Coordination Department at 1-866-219-5411.
TCHP’s assigned Service Coordinator must be contacted should a STAR Kids member have one. Providers can reach the Service Coordination department at 832-828-1004 or 1-877-213-5508.
If you are unsure of the Service Coordinator, or the member does not have a Service Coordinator, you must contact our Care Coordination Department at 1-866-219-5411.
Additionally, TCHP’s Service Coordinators are available to assist with emergency preparedness plans, identifying coverage, and to review and assess members based on the complexity and frequency of their care needs. Notifications and explanations related to changes need to be discussed with the member and their legally authorized representative. You can access these resources by contacting the Service Coordination department for the STAR Kids member at TCHP by calling 832-828-1004 or 1-877-213-5508.
Prior Authorization requirements are available on our website, click here to view this guidance.
A toolkit for speech therapy, physical therapy, and occupational therapy is available on our website, click here for Provider Resources.
Texas Children’s Health Plan follows the Texas Medicaid Provider Procedures Manual. Section 5 (5.1) permits prescribing or ordering providers, dispensing providers, clients’ responsible adults, and clients to sign prior authorization forms and supporting documentation using electronic or wet signatures.
For information on billing and claim administration, please refer to our Provider Manual.
Electronic Visit Verification
For information on EVV, please see information on our Electronic Visit Verification resource page.
HHS STAR Kids
Visit the HHS STAR Kids website at https://hhs.texas.gov/services/health/star-kids.
Department of Family and Protective Services (DFPS)
Visit the Department of Family and Protective Services website for policies and information https://www.dfps.state.tx.us/I_Am/teachers.asp