Monthly Archives - April 2017

Provider Alert!

Provider Alert! STAR Kids Prescription/Pharmacy Prior Authorizations Reinstated 4/15/17

PRESCRIPTION PRIOR AUTHORIZATION NOTIFICATION Subject: STAR Kids Prescription/Pharmacy Prior Authorizations Reinstated 4/15/17 Effective 4/15/17, Texas Children’s Health Plan (TCHP) will enforce pharmacy prior authorization (PA) requirements for STAR Kids members STAR Kids members who received a prescription between 11/1/16-4/15/17 were not subject to normal PA requirements. PA requirements were temporarily lifted during this period to help facilitate the transition to STAR Kids. After 4/15/17, all prescriptions for STAR Kids members will be subject to normal PA documentation, including non-preferred drugs and drugs that require...

Inpatient Authorization Requests through Clear Coverage

Texas Children’s Health Plan is excited to announce the upcoming implementation of Clear Coverage for inpatient authorization requests beginning May 1, 2017. Clear Coverage is a web-based system that provides an automated method for providers and health plans to manage authorizations for inpatient services at the point of decision. Clear Coverage enables automated authorization, notification, eligibility and direction of members to in-network service providers. Clear Coverage provides the following benefits: Providers have immediate access to coverage, medical appropriateness and network rules,...