All Texas Children’s Health Plan providers and facilities Utilization Management Guidelines effective November 1, 2016

Texas Children’s Health Plan has developed Utilization Management guidelines that serve as criteria for the determination of medical necessity for services that require prior authorization. These guidelines will be effective on November 1, 2016. The goal of Texas Children’s Health Plan’s Utilization Management guidelines is to encourage the highest quality care from the right provider in the right setting. Utilization Management guidelines are available for you to review. Please contact Texas Children’s Health Plan’s Provider Relations department at 832-828-1008 or toll-free at 1-800-731-8527 if you would like to request a copy.