Provider Alert! External Medical Review Provider Training now availableTexas Children's Health Plan
Date: April 5, 2022
Attention: All Providers
Effective date: February 28, 2022
Call to action: TCHP would like to inform providers of training on External Medical Review (EMR) available from the Health and Human Services Commission. The purpose of this training is to provide an overview to providers on the role/responsibilities for participants involved in an EMR following receipt of an Adverse Benefit Determination from a MCO or dental contractor.
TCHP follows the guidance on (EMR) in accordance with the Uniform Managed Care Manual, Chapter 3.21.1 and Senate Bill 1207. The resource document available here outlines the different aspects of this process that are completed by designated Independent Review Organizations (IROs) when there are service denials, reductions, and eligibility denials for certain programs based on medical or functional necessity made by TCHP.
How this impacts providers:
Provider EMR Training:
Next steps for providers: Providers are encouraged to complete the EMR training.
If you have any questions, please email Provider Network Management at: email@example.com.