Provider Alert! COVID-19 Disaster Declaration – Prior Authorization AdjustmentsTexas Children's Health Plan
Attention: All Providers
Effective Date: March 18, 2020
TCHP affiliated providers should monitor the TCHP Provider Portal regularly for alerts and updates associated to the COVID-19 event. TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event.
Call to action:
As are result of the COVID-19 Disaster Declaration, TCHP has instituted the following:
- In order to increase access to primary care services, TCHP is now waiving prior authorization requirements for out-of-network primary care visits (Pediatrician, Family Practice/General Practice, Internal Medicine, OB/Gyn) an authorization will not be needed for these services while the COVID-19 State of Disaster Declaration is in place. When the service requested by a Primary Care Provider requires authorization, the service should be reviewed for medical necessity (e.g. genetic testing) as part of the authorization process
- Authorizations requested by out-of-network (OON) providers for other services may be approved when the member is unable to access in-network services during the COVID-19 State of
- LTSS service authorizations expiring in March will be extended for 120 days and those expiring in April will be extended for 90 days.
- TCHP will approve extensions of existing authorizations for services when the provider states that the member was unable to access services while the COVID-19 State of Disaster is in place. Authorization extension can be given 30 days at a time.
- For LTSS, PDN, therapy, and DME services, TCHP may waive the “change of provider” letter requirements and approve changes of a previously approved or authorized provider at the provider/member request without formal documentation. Providers/members should state “Need to Change Provider, COVID-19” in the request.
- We will temporarily waive hearing screen and well-child requirements for therapy approvals for services that start during the COVID-19 State of Disaster Declaration or for extension requests that are requested during this time.
How this impacts providers:
- This means a claim for out-of-network (OON) PCP office visits (see the above listed provider types) will pay during the COVID-19 Disaster Declaration.
- Certain authorizations as stated above will be waived, relaxed or granted automatic extension.
- In cases where authorization extensions are granted Provider should expect to receive a notice of extension
- Certain supportive diagnostics and testing will be waived as stated above.
Next steps for providers:
- If your request involves a “change of provider,” you must ensure your request includes the following message “Need to Change Provider, COVID-19.” TCHP staff will contact you if further information is needed to process the change request.
If you have any questions, please email Provider Network Management at: firstname.lastname@example.org.
For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.