Provider Alert! TCHP Prior Authorization Requirement

Provider Alert! TCHP Prior Authorization Requirement

Effective January 1, 2019, TCHP will be updating the prior authorization listing.

Please note there are some key changes for providers.

Removed from the list and will no longer require prior authorization:

  • Baclofen Pump

New to the list:

  • Home Telemonitoring

Updates:

  • Ambulance (non-emergent transport) has been updated to Non-Emergency Ambulance Transport.
  • Augmentative Communication Device has been updated to Augmentative Communication Device and Accessories.
  • Chemotherapy non-FDA approved has been updated to Non-FDA approved medications.
  • Cranial Molding Orthosis (Helmets) has been updated to Cranial Molding Orthosis.
  • High cost (>$50,000) injectable in the outpatient setting has been updated to High cost (>$50,000) injectable drugs in the outpatient setting.
  • Implantable Hearing Device has been updated to Implantable Hearing Device (excluding batteries).
  • Nutritional Supplements has been updated to Nutritional Supplements (for oral nutrition and adults).
  • Oral Surgery has been updated to Oral Surgery and Medically Necessary Dental Procedures.
  • Sleep Studies in Children has been updated to Sleep Studies in Children (under 18 years old).

The new TCHP prior authorization list will also be posted at: https://www.texaschildrenshealthplan.org/for-providers/provider-resources

If there are further questions, please contact the Provider Relations Department at 1-800-731-8527.

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