UM – The Checkup

Provider Alert! Retracted: Coordination of Benefits for Utilization Management Update

Date: April 19, 2023 Attention: All Providers Call to action: As you may remember, Texas Children’s Health Plan (TCHP) previously communicated changes to our Coordination of Benefits Procedure on February 15, 2023. After careful consideration and listening to your concerns, the Utilization Management (UM) team has decided to pause on any changes and revert back to the original procedure. A link to the former procedure that is currently being followed is available here. How this impacts providers: Providers that received a rejection letter due...

Provider Alert! All Texas Children’s Health Plan providers and facilities Utilization Management Guidelines effective November 1, 2016

Texas Children’s Health Plan has developed Utilization Management guidelines that serve as criteria for the determination of medical necessity for services that require prior authorization. These guidelines will be effective on November 1, 2016. The goal of Texas Children’s Health Plan’s Utilization Management guidelines is to encourage the highest quality care from the right provider in the right setting. Utilization Management guidelines are available for you to review. Please contact Texas Children’s Health Plan’s Provider Relations department at 832-828-1008 or toll-free at...

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