Provider Alert! Appointment Availability Standards Reminder
Date: November 3, 2022
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 providers of the appointment availability standards.
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.
Primary Care Providers, a reminder that a referral is not needed to see an in-network specialist.
*For more information on behavioral health guidelines see the provider alert, http://www.thecheckup.org/2021/02/12/provider-alert-attention-behavioral-health-providers-and-inpatient-facilities/.
Next steps for providers: Providers should share the appointment availability standards with their staff and implement internal procedures for compliance, if needed.
If you have any questions, please email Provider Network Management at: email@example.com.