Monthly Archives - March 2018

When to See a Doctor Stoplight Tool

Texas Children’s Health Plan has added the “When to See a Doctor” stoplight tool, a new resource to help providers educate patients about the appropriate care venue. Its purpose is to assist in reducing preventable emergency room (ER) visits through parent education on appropriate indicators for home, provider office, and ER care. Providers simply fill in the information during an office visit and hand the stoplight tool to parents. The stoplight tool is simple, quick, and free to download here . Heidi Schwarzwald MD [...]

5 steps to a Successful Authorization

Know what requires a prior authorization. Go to or to check prior authorization requirements for Medical/Behavioral Health services before providing services or sending prescriptions to the pharmacy. Become familiar with the authorization guidelines. Guidelines are available upon request and on the Texas Children’s Health Plan Provider TouCHPoint portal at Submit requests in advance of the scheduled service. Authorizations for outpatient services can take 3 business days to process. Ensuring that submissions are done in advance will avoid potential claim denials. Be comprehensive [...]

Substance Use and Pregnancy

According to a 2017 report by Texas Health and Human Services, the most commonly used substances by Texas women include stimulants, hallucinogens, opioids and synthetics, and alcohol. While use and misuse are an area of clinical concern when seen in any patient, it is of particular concern when seen in in the context of pregnancy. Prevention is a key intervention; for patients already using, intervention can occur on many levels including residential and ambulatory detoxification, outpatient and residential treatment [...]

Save the Date for our May 10 CME!

A Healthier Tomorrow: Innovations in Well Child Care A Grand Rounds CME provided by Texas Children’s Hospital and presented by Texas Children’s Health Plan Panel presentation by: Cesar Ortega, MD Stephanie Marton, MD Carl Tapia, MD When: Thursday May 10, 2018 Registration and Dinner – 5:30 p.m. Presentations – 6 p.m. Online registration, site locations, and more information at: Free registration for Texas Children’s Health Plan contracted providers

Perinatal Depression

Depression is very common, especially in women of reproductive age. Perinatal depression affects as many as one in seven women. It includes major and minor depression episodes that occur during pregnancy and the postpartum period. The American College of Obstetricians and Gynecologists (ACOG) recommends that all pregnant women be screened at least once during the perinatal period. Identification of perinatal depression is important because untreated perinatal depression and other mood disorders can have devastating effects on women, infants, and [...]

Partner with Texas Children’s Health Plan to combat childhood obesity!

Keep Fit is a value-added service for Texas Children’s Health Plan members. The program encourages healthy eating, exercise, and positive self-esteem through a 4-week exercise and nutrition class that includes healthy cooking demonstrations and exercise activities. You can refer your patients via

Be a HEDIS HERO for Childhood Wellness

The National Committee for Quality Assurance (NCQA) is a non-profit organization that measures the quality of healthcare across large populations. NCQA does this through its Health Effectiveness and Data Set, also known as HEDIS. HEDIS measures are a set of evidence based standards that Texas Children’s Health Plan is committed to improving upon in order to provide the best care for our members. Making changes across your patient population is easier than you think! In fact, you can become a [...]

Appointment Availability Standards

Appointment availability standards What are appointment availability standards? How do you as a provider with Texas Children’s Health Plan play a role? In 2015 Senate Bill 760 passed, requiring Texas Health and Human Services Commission (HHSC) to monitor the provider networks of managed care organizations. Texas Children’s Health Plan would like to ensure members are able to schedule appointments with providers in accordance with the HHSC’s appointment accessibility guidelines. AFTER HOURS: Primary Care Physicians Accessible 24 hours a day, seven days a week, [...]