Tag - Authorization

Provider Alert!

Provider Alert! Authorization and Verification Process Updates

Subject:   Authorization and Verification Process Updates   Texas Children’s Health Plan (TCHP) has made updates to the authorization process. The following outlines a summary of the changes.   Individual Member Fax Requests To ensure Health Insurance Portability and Accountability Act (HIPAA) compliance, providers must send one fax request per member with each fax having its own cover sheet. Requests received with multiple members per fax will be returned to the provider and not processed.   Minimum Information Required to Process a Request *Providers must use the Texas Standard [...]

Key Changes to TCHP Therapy Authorization Guidelines

When services were not prior authorized by Texas Children’s Health Plan, (through another MCO or TMHP) the authorization request must include: A copy of the previously approved authorization letter. All of the documentation that was sent in the original authorization request to the previous MCO or TMHP, including any physician orders that were used to determine the start of care. If the services requested do not meet TCHP criteria, the services will be honored for the shorter of 90 days or until [...]

Provider Alert!

Provider Alert! Authorization Extension for STAR Kids Members (Revised)

The Health and Human Services Commission (HHSC) expects managed care organizations to extend longterm services and supports (such as Personal Care Services, Community First Choice, and Private Duty Nursing) authorizations for services until completion of the STAR Kids Screening and Assessment Instrument (SAI), but no longer than July 1, 2017. In compliance with HHSC’s guidance and as required by the STAR Kids contract, STAR Kids managed care organizations must assess each enrolled member by completing the STAR Kids Screening and [...]

Provider Alert!

Provider Alert! New Fax Number for STAR Kids Private Duty Nursing Prior Authorization

Attention STAR Kids Providers Texas Children’s Health Plan New Fax Number for STAR Kids Private Duty Nursing Prior Authorization To expedite the prior authorization process for Texas Children’s Health Plan for STAR Kids, please begin faxing to 346-232-4757 for outpatient prior authorization for the following service. Private Duty Nursing The Prior Authorization Request Form is conveniently located on the STAR Kids website at http://www.texaschildrenshealthplan.org/sites/default/files/pdf/20150410_Standard%20Prior%20Auth%20Form.pdf. Please contact your dedicated Provider Service Representative toll-free at 1-800-731-8527 with any questions. Thank you for your commitment to your Texas Children’s [...]

TCHP now accepts Outpatient Authorizations for many services online via Clear Coverage effective June 1, 2017!

Tired of faxing authorization requests and medical records? Spending too much time on hold waiting to speak to an Authorization Specialist for non-urgent authorization request? Looking for a faster, more efficient way to submit authorizations? Why not submit your authorizations request through Clear Coverage? What are the benefits? Easy to access 24/7 online access to Clear Coverage Receive real time authorization status by viewing your office’s home page in Clear Coverage Services are immediately uploaded into Texas Children’s Health Plan’s authorization for clinical review Automatic APPROVALS may [...]

Provider Alert!

Provider Alert! Effective Provider Alternate Addresses

Attention: all Texas Children’s Health Plan Providers Subject: Provider Alternate Addresses Medicaid enrolled providers must have all service locations reflected in their state enrollment record prior to Medical Transportation Program (MTP) authorizing transportation for a client to the provider’s location. If an alternate address is not listed within the provider’s file sent to MTP, authorization will be denied. This means that every address where a provider will perform services has to have an active attested TPI. If all service locations are not [...]