Quick Reference Guide

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: 1-800-731-8527
Telephone TouCHPoint: 832-828-1007
Fax: 832-825-8750

Texas Children’s Health Plan Fraud and Abuse

Report Fraud, Waste and/or Abuse

Suspected fraud, waste or abuse (FWA) by recipients or providers can be reported to the Office of Inspector General (OIG) and/or Texas Children’s Health Plan’s Special Investigations Unit (SIU). Texas Children’s Health Plan’s Fraud, Waste, and Abuse Hotline is a dedicated resource designed specifically for our Network Providers. We understand the critical importance of maintaining the highest standards of integrity and compliance within our healthcare network. The hotline is 866-828-4924, or visit https://tchpintegrity.com/.

You can reach Texas Children’s Health Plan Controls and Compliance Department at 832-828-1320
Fax Number: 832-825-8722
Email: TCHPSIU@texaschildrens.org

Office of Inspector General: FWA Reporting
Website: https://oig.hhsc.texas.gov/report-fraud-waste-or-abuse

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® Link

Texas Children's® Link is a web-based provider portal that allows secure, convenient 24-hour access to our member’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. Click here to learn more.

Texas Children’s® Link How-To Videos are available here.

Password Resets: TCHP strongly encourages you to set up your challenge questions when you first log in to the provider portal. If you forget your password, you’ll be able to reset the password yourself by answering those questions that you’ve previously set up. If your password expires due to non-use for 90 days or you need a password reset, please call TCHP at 832-828-1004. The representative will document needed information for our IS team and then send the information over so your password can be reset within the next 24 to 48 hours.

For a new account:Click here
Only one registration form is necessary per office.

For further assistance, email Provider Relations at ProviderRelations@texaschildrens.org

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 (STAR): 1-800-516-0165
DentaQuest (CHIP): 1-800-508-6775
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

1. All genetic testing
2. All out-of-network services
3. Ambulance services (non-emergent transport)
4. Augmentative Communication Devices
5. Baclofen injections/pump
6. Bariatric Surgery
7. Botox Injections
8. Chemotherapy non-FDA approved
9. Circumcision greater than 1 year of age
10. Cochlear Implant
11. Cosmetic Surgery
12. Cranial Molding Orthosis (Helmets)
13. Dental Medically necessary (except for cleft palate)
14. Gait trainer
15. Home Health Care
16. Hospital grade Blood Pressure Monitors in home use
17. Hospital Beds and accessories
18. Hospital Inpatient care
19. Makena Injections
20. Nutritional Supplements
21. Oral Surgery
22. Organ Acquisition
23. PET Scans
24. Prescribed Pediatric Extended Care Centers
25. Private Duty Nursing in home
26. Prosthetics
27. Skilled Nursing facility
28. SPECT Scans
29. TMJ diagnosis and treatment
30. Transplant Evaluation
31. Vision Care, medically necessary
32. Wheelchairs and accessories

  Behavioral Health Authorizations

1. All out-of-network services
2. Inpatient Care
3. Intensive Outpatient Treatment
4. Neuropsychological Testing (exceeding limits)
5. Outpatient Behavior Health visits greater than 30 (per Calendar year)
6. Partial Hospitalization
7. Psychological Testing (exceeding limits)
8. Residential Treatment Facility
9. Targeted Case Management
10. Substance Use Disorder Treatment (excluding assessment, outpatient treatment services unless limits exceeded, and Medication Assisted Treatment 

Utilization Management

Urgent authorization requests:

Phone: 832-828-1004, option 2
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 2
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.

Laboratory Services

Lab tests should be referred to TCHP in network labs or State of Texas Laboratories. Some laboratory services may require prior authorization. To access a specific list of labs on our pre-approved list that may be run in a network provider’s office, click here.

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
STAR Kids: 1-844-818-0125

Provider and Vendor Check Payments (Refunds)

Texas Children's Health Plan
P.O. Box 841976
Dallas, TX 75284-1976

Available online at www.tchp.us/providers/ or by contacting Provider Relations for a faxed copy.