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ALERT! We now encourage our patients to save their spot in line before coming into the clinic.

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ATTENTION MEMBERS: Flexible appeal policy ending soon! | Learn more

MEMBERS: Remember to take the annual CAHPS Survey! | Learn more

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For Providers

Attention Providers!

The Texas Vendor Drug Program (VDP) have made recent changes to Texas Medicaid drug formulary. This will be in effect January 26, 2023 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.

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.

Dear Texas Children’s Health Plan providers, it has been brought to our attention that a small portion of our new members did not receive their current Member ID cards. We have already begun the process of sending the missing ID cards to members and will continue to do so until they are all properly distributed. We ask that you do not turn members away if they cannot present an ID card and instead utilize one of the following ways to verify their enrollment.

Alternatives to validate member eligibility:

We appreciate your patience and apologize for any inconvenience this may cause to your operations. Should you have any questions or concerns please contact your Provider Relations Liaison or the Provider Relations Department at 832-828-1004 or 800-731-8527.

Our website for providers is designed as a tool to help you. You can find an array of resources such as:

Provider Manuals

Helpful links

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