Provider Alert! Reminder: Appointment availability standards for Obstetric providersTexas Children's Health Plan
Attention: Obstetric Care Providers
Effective Date: June 16, 2020
Providers should monitor the Texas Children’s Health Plan (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: Texas Children’s Health plan (TCHP) would like to remind our Obstetric Care providers of the appointment availability standards recognizing the importance of the adherence to the standards. Network providers must be available to members for routine, urgent, and emergent care as noted in the table below.
|Level/Type of Care||Appointment Availability Standards|
|Urgent Condition||Within 24 hours|
|Initial appointment for prenatal care||14 days|
|Initial prenatal care appointments for high-risk pregnancies or new members in third trimester (≥ 24 weeks)||Initial appointment must be offered within 5 days, or immediately, if emergency exists|
|Appointments for ongoing OB care must be available in accordance with treatment plans developed by the provider||Must be available in accordance to the treatment plan as developed by the provider|
How this impacts providers: Providers must adhere to the appointment availability standards and pay close attention to conditions that would qualify as a high-risk pregnancy when speaking with a member to schedule an appointment. Listed below are some conditions that may cause a pregnancy to be considered high-risk:
- Pre-gestational diabetes and gestational diabetes
- Multiple gestation (twins, triplets, etc.)
- Chronic hypertension and other hypertensive disorders of pregnancy (such as preeclampsia)
- Advanced Maternal age (≥ 35 years)
- Gestational age ≥ 24 weeks or after “6 months” of pregnancy, other health conditions and lifestyle issues
- Pregnancies may be designated as high-risk if the mother has a health condition such as heart disease, kidney disease, autoimmune disease, thyroid disease, substance use disorders or HIV/AIDS.
Next steps for providers: Providers should remind their staff of these standards and train them on methods to schedule appointments appropriately. You may consider creating a list of relevant conditions to place by the schedulers’ phones.
If you have any questions, please email Provider Network Management at: firstname.lastname@example.org.