Provider Alert! Regulatory Guidelines & Appointment Availability Standards Reminder

Attention: Primary Care and Specialist 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 appointment availability standards and regulatory requirements. 
In 2015, Senate Bill 760 passed, requiring Texas Health and Human Services Commission (HHSC) to monitor the provider networks of managed care organizations. Texas Children’s Health Plan would like to ensure members are able to schedule appointments with providers in accordance with the HHSC’s appointment accessibility guidelines. 

How this impacts providers:  Texas Children’s Health Plan enforces access and other network standards required by the contract and takes appropriate action with providers whose performance is determined by the health plan to be out of compliance. In addition, providers and staff are responsible for understanding the requirements.  

  Provider Demographic Changes:  

• Demographic changes must be sent in writing.  
• TCHP is not responsible for potential claims processing and payment errors due to failure to update information.  
• Notification of change can be completed by accessing the form on the provider web page or portal at https://www.texaschildrenshealthplan.org/for-providers, once completed, fax to (832) 825-8750 or emailed to providerrelations@texaschildrens.org .  Here is the form you will need to complete: 

• Provider Information Form– to add a new provider or new location to your group.  
• Provider Information Change Form– to submit demographic changes, like the ones listed below. 

Network providers must also notify TMHP of any demographic changes. The form can be found here:
http://www.tmhp.com/Provider_Forms/Provider%20Enrollment/F00114_Provider_Information_Change_Form.pdf 

Authorizations
Primary Care Providers, a reminder that a referral is not needed to see an in-network specialist.

APPOINTMENT AVAILABILITY STANDARDS  

*Accessibility Standards set by National Committee for Quality Assurance 

Next steps for providers: Providers should share the appointment availability standards and regulatory guidelines with their staff and implement internal procedures for compliance, if needed.  

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.