Provider Alert! Providers who are leaving the TCHP Participating Provider Network

By tcph OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialists provider network 0 Comments

Attention: All Providers

Effective Date: State Fiscal QTR 3 & 4

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 and its continued governmental Emergency Declaration.

CHANGES TO THE TCHP PARTICIPATING PROVIDER NETWORK

The following is a list of providers and practitioners that have left and/or will be leaving the TCHP participating provider network. Providers and members can find an up to date listing of current network providers using the TCHP Online Directory by linking to https://www.texaschildrenshealthplan.org/find-a-doctor.

Last Name	First Name	Individual NPI API	Program	Provider Specialty	Termination Effective Date
Chopra	Atul	1457672826	STARKids STAR CHIP	Internal Medicine	4/1/2020
Bennett	J.	1699741520	STARKids STAR CHIP	Orthopedic Surgery	3/30/2020
APPLE Homecare Medical Supply	–	1649259797	STARKids STAR CHIP	DME/Medical Supplier	9/1/2020

How this impacts providers:

TCHP understands that access to care and continuity of care is of utmost importance to our members and participating providers. Therefore, the following provides guidance on how to coordinate care and services for our members during the provider’s transition period. If you need assistance at any time, please contact TCHP Member Services Department:

STAR: 832-828-1001 or 1-866-959-2555
CHIP: 832-828-1002 or 1-866-959-6555
STAR Kids Members- contact their assigned Service Coordinator. If you need this information, please call 1-800-659-5764.
Additional resources:
texaschildrenshealthplan.org/TCHP Utilization Management Guidelines
Providers are expected to use in-network providers for patient referrals. In-network providers can be found at: https://www.texaschildrenshealthplan.org/find-a-doctor. There may be times when a Primary Care Provider (PCP) believes it is critical for a member to receive care from a provider outside of the TCHP network. In these cases, the PCP should initiate a written authorization in order for the visit to be covered. These requests are reviewed by the Medical Director for authorization of medically necessary services that are not available from any other TCHP network provider.

Through the date of termination	Continuity of care period beginning on the effective date of termination for members of special circumstance
Provider remains in network for all members.	For a member who at the time of termination is past the 24^th week of pregnancy, the continuity of care period is the effective date of termination – delivery of a child and 6 weeks post-partum care.	For a member who at the time of termination has been diagnosed with a terminal illness, the continuity of care period is the effective date of termination – (not to exceed) 9 months post termination.	For “all other” members, the continuity of care period is the effective date of termination – (not to exceed) 90 days post termination.
TCHP Care Coordination teams are actively assisting members who wish to transition providers and, as of the termination effective date, will assist with transitioning to in-network providers. Members and Providers can reach TCHP Care Coordination at 1-800-659-5764.	TCHP will review cases and continuation of authorization requests to use the provider only in cases where there is an existing member provider relationship. TCHP will take into consideration the needs of the member related to their care and safety.	TCHP will review cases and continuation of authorization requests to use the provider only in cases where there is an existing member provider relationship. TCHP will take into consideration the needs of the member related to their care and safety.	TCHP will review cases and continuation of authorization requests to use the provider only in cases where there is an existing member provider relationship. TCHP will take into consideration the needs of the member related to their care and safety.
Providers should expect to receive new agency requests for orders/signature.	TCHP will support the existing service plan and authorized services during the continuity of care period for which treatment may be continued for a period that includes delivery of the child, immediate postpartum care, and the follow-up check-up within the first six (6) weeks of delivery.	If TCHP determines the member meets continuity of care criteria for members with a special circumstance, TCHP will follow its continuity of care processes. In the case of a member who at the time of termination has been diagnosed with a terminal illness, treatment may be continued for 9 months after the effective date of termination.	If TCHP determines the member meets continuity of care criteria for members with a special circumstance, TCHP will follow its continuity of care processes. In the case of “all other” members, treatment may be continued for 90 days after the effective date of termination.

Next steps for providers:

If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.

For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.

Provider Alert! Providers who are leaving the TCHP Participating Provider Network