5 steps to a Successful AuthorizationTexas Children's Health Plan
- Know what requires a prior authorization.
Go to TexasChildrensHealthPlan.org or Navitus.com 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 TexasChildrensHealthPlan.org/for-providers.
- 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 in clinical documentation.
Establish a protocol to consistently document data required for prior authorization in the medical record, which can help avoid delays in patient therapy, prevent potential follow-ups with patients for additional information, and minimize time spent on authorization.
- Submit all required information.
Incomplete documentation can delay the authorization process. Know what documentation is required and submit it with the authorization request.
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