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Prior Authorization Requirements will be Changing in January 2024
Date: October 6, 2023
Attention: All Providers
Effective date: January 2, 2024
Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that there will be changes to the prior authorization requirements that become effective on January 2, 2024.
Click here to view the requirements. Another resource, Prior Authorization Reference Information, is a searchable Prior Authorization list linked to the code tables for each benefit category and accessible here.
How this impacts providers: The medical services listed on the Prior Authorization Requirements document all require prior authorization. A check mark indicates the medical service is a covered benefit if medical necessity criteria are met and with a prior authorization. All services will be subject to benefit limitations.
Next step for providers: Providers should review the document now in preparation for the changes and share this communication with their staff.
Prior authorization submission: It is highly recommended that providers submit their prior authorization request via the provider portal, Texas Children’s® Link for a more efficient process. From the portal, providers have access to prior authorization guidelines, authorization status, and to appeal a prior authorization. For instructions on how to perform these tasks, go to Quick Links on the homepage of the portal. To learn more about Texas Children’s® Link, click here. You can directly access Texas Children’s® Link by clicking here.
To learn more about submitting prior authorizations, there are some helpful ‘How-To Videos’ accessible on the provider portal under Quick Links.
Standard Prior Authorization Form
Prior Authorization Fax Lines
- Medical Inpatient Admissions and Discharge Notifications - 832-825-8462 or Toll-Free 844-663-7071
- Medical Services Fax Line - 832-825-8760 or Toll-Free 1-844-473-6860
- Behavioral Health Services Fax Line - 832-825-8767 or Toll-Free 1-844-291-7505
- LTSS and Private Duty Nursing Fax Line - 346-232-4757 or Toll-Free 1-844-248-1567
- Post Hospital Discharge Authorizations Fax Line - Toll-Free 866-839-9879
Prior Authorization Determinations
The Utilization Management department processes service requests in accordance with the clinical immediacy of the requested services.
Authorization | Turnaround Time
Routine— within 3 business days after receipt of request
Urgent— within 1 business day after receipt of request
Inpatient— within 1 business day after receipt of request
TCHP does not require prior authorization for Emergency Medical Conditions or Emergency Behavioral Health Conditions
Post hospital discharge services— within one business day
If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org.
For access to all provider alerts,log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.