For Providers
Attention Providers!
Texas Children’s Health Plan (TCHP) would like to share important information on checks sent by Change Healthcare. TCHP has been notified that due to a process failure at Change Healthcare, a number of invalid checks have been erroneously issued. These paper checks were issued to a number of our providers for amounts previously paid via check or electronic funds transfer (EFT) dating back to February 20, 2024. These checks are not valid and should not be deposited. Please review the Provider Alert for more information.
- TCHP has activated an alternative payment process that will be in effect until Optum’s Change Healthcare process is restored. Click here to view the Provider Alert
- Texas Children’s® Link, Online Provider Portal Claim Submission Guidance
- Important Information for Checks Dated February 27, 2024
- Availity Now Offered to Providers for Electronic Claims Submission
- The Vendor Drug Program (VDP) will make changes to the Texas Medicaid drug formulary. This is in effect as of January 26, 2024 on select medication(s) moving from “preferred” to “non-preferred” status and vice-versa. To learn more about formulary changes impacted, please click here for more information.
- 2023-24 RSV Season Updates, please click here to view the Provider Alert.
Network providers must maintain their enrollment and demographic information with Texas Medicaid Healthcare Partnership (TMHP). Provider Medicaid enrollment functions are available through Provider Enrollment and Management System (PEMS). Updates to provider’s current enrollment, new practice locations or change of ownership updates, can be made on this site titled ”Provider Enrollment and Management System (PEMS)”, accessible here.
For instructions on how to make other demographic updates to your current enrollment, access the site titled “Provider Enrollment Help”, accessible here.
Click here to view the Provider Alert.
Our website for providers is designed as a tool to help you. You can find an array of resources such as:
- Pharmacy Directories
- Downloadable forms
- Claims information
- Practice guidelines
- Provider Newsletters
- Contracting and Credentialing
Provider Manuals
Helpful links
- Medicaid Autism Services Flyer: Applied Behavior Analysis Services
- Screening and Coding for Social Determinants of Health
- Texas Health and Human Services
- Texas Health Steps Culturally Effective Health Care online course
- Texas Health Steps Additional Courses
- Texas Health Steps Provider Information
- Texas Health Steps Regional Representative Contact List
- Texas Medicaid/CHIP Vendor Drug Program
- Texas Medicaid & Healthcare Partnership
Member Rights and Responsibilities
Clinical and Administrative Advisory Committee, Behavioral Health Advisory Committee, Perinatal Advisory Committee
These Provider Advisory Groups provide recommendations to Texas Children’s Health Plan in the following areas:
- Identification and review of clinical practice guidelines and prior authorization guidelines;
- Review of general utilization patterns and assessment of Provider compliance with clinical guidelines;
- Recommendations for member engagement and quality improvement programs to improve health outcomes and keep members healthy
- Strategies and recommendations for improving Health Plan administrative processes;
- Recommendations on how to improve care based on Member feedback and their personal experiences serving our Members; and
- Opportunities for connecting network Providers and Managed Care Organization clinical experts for purposes of peer support and sharing best practices.
There is a Clinical and Administrative Advisory Committee for each of our three Service Areas:
- Harris
- Jefferson
- Rural Service Area Northeast
The Behavioral Health Advisory Committee and Perinatal Advisory Committee meet in the Harris Service Area.
The meeting cadence for each of the committees are as follows:
- Clinical and Administrative Advisory Committee meets 9 times per year in the Harris Service Area and quarterly in the Jefferson and Rural Service Area Northeast
- Behavioral Health Advisory Committee meets quarterly
- Perinatal Advisory Committee meets quarterly