Tag - appeal

Attention: Star Kids Providers: Prior Authorization required on all Vendor Drug Program (VDP) identified medications

Texas Children’s Health Plan requires prior authorization (PA) on all medications on the VDP website prior to dispensing to members. To obtain a list of medications requiring prior authorization, visit the VDP website at: http://www.txvendordrug.com/formulary/preferred-drugs.shtml Providers can also view instructions on accessing and using the formulary at the Texas Children’s Health Plan website: http://www.thecheckup.org/2016/06/09/do-you-know-how-to-access-the-texas-childrens-health-plan-formulary/ Providers can submit PA documentation to Texas Children’s Health Plan’s pharmacy benefit manager, Navitus. PA forms can be found here: https://www.navitus.com/texas-medicaid-star-chip/prior-authorization-forms.aspx Prior authorizations need to be submitted to Navitus by faxing to...

Prevent Behavioral Health Readmissions

Prevent Behavioral Health Readmissions Poor access to prescribed medications after discharge is one of the most common reasons for behavioral health readmissions. One effective way to help ensure access to medications post-discharge is to obtain and verify prior authorization for the medications before discharge. Texas Children’s Health Plan follows the state of Texas Medicaid Guidelines for the use and approval of antipsychotics in children. Criteria for approval can be accessed here. If a patient does not meet criteria and the prior authorization...