Tag - Authorization

Provider Alert!

Provider Alert! Macrolides Clinical Prior Authorization Update

Date: February 19, 2021 Attention: Primary Care Providers Effective Date: March 15, 2021 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 inform network providers that beginning March 15, 2021 Texas Medicaid will change the preferred drug list [...]

Provider Alert!

Provider Alert! Transport to and from Shelters

Date: February 17, 2021 Attention: Ambulance Transport Companies Effective Date: February 15, 2021 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: In response to the current weather conditions, effective February 15 through February 19, 2021, Texas Children’s Health Plan will reimburse for ambulance transportation of [...]

Provider Alert!

Provider Alert! Online Authorization Platform is Now Operational

Date: January 13, 2021 Attention: All Providers   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 inform providers that utilize our online authorization platform; Health Trio this platform is restored and is now functional and accepting authroizations. How [...]

Provider Alert!

Provider Alert! Essential Information for Prior Authorization Submission

Date: January 13, 2021 Attention: All Providers 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 network providers of the required information for a prior authorization submission. The Texas Standard Prior Authorization Form* including the following information: Member [...]

Provider Alert!

Provider Alert! TCHP Fax Lines Availability: Fax lines open 24/7

Date: January 16, 2020 Attention: TCHP Providers Effective Date: January 6, 2020 Call to action: We are excited to announce that Texas Children’s Health Plan has made updates to the availability of the fax lines for authorization requests. The following outlines a summary of the changes. Beginning January 6, 2020, TCHP fax lines are open to receive requests for authorizations 24/7. This is a change to the former procedure to receive faxed requests for authorizations during normal business hours (Monday-Friday, 8a.m. – 6p.m.). Now [...]

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 [...]