ALERT: Stay healthy this cold and flu season! Learn more
ALERTA: ¡Mantente sano durante esta temporada de influenza y resfriados! Más información
For Providers
Attention Providers!
With ongoing cases of highly contagious respiratory illnesses, it is important to remind patients to protect themselves and their families by getting routine vaccinations.
Please explore these provider resources to learn more:
- Essential Reminders for Providers During Respiratory Viral Illness Season (Provider Alert)
- HEDIS Toolkit on Respiratory Conditions and Antibiotic Stewardship
- Respiratory Viral Illness Season Resource Kit
- 2024-2025 Flu Season: Encourage Members to Protect Themselves (Provider Alert)
- 2024–25 RSV Season and Synagis Prior Authorization for All State Health Service Regions (Provider Alert)
- Flu information flyer for providers to share with patients
- The Vendor Drug Program (VDP) made changes to the Texas Medicaid drug formulary effective August 8, 2024. To learn more about formulary changes impacted, please click here for more information.
Texas Children’s Health Plan (TCHP) would like to inform providers that effective January 6, 2025, there will be changes in how TCHP will receive updates for provider directory information and provider network maintenance. This change will improve the provider experience by utilizing Texas Medicaid & Healthcare Partnership’s (TMHP) Provider Enrollment Management System (PEMS) data as the source of truth for populating demographics in the TCHP directory. Click here to view the Provider Alert
For more information about PEMS, visit http://www.tmhp.com/topics/provider-enrollment and step-by-step guide on using PEMS, visit https://www.tmhp.com/topics/provider-enrollment/pems/start-application
Latest Provider Alerts
Our website for providers is designed as a tool to help you. You can find an array of resources such as:
- Pharmacy Directories
- Downloadable forms
- Claims information
- Practice guidelines
- Provider Newsletters
- Contracting and Credentialing
Provider Manuals
Helpful links
- Medicaid Autism Services Flyer: Applied Behavior Analysis Services
- Screening and Coding for Social Determinants of Health
- Texas Health and Human Services
- Texas Health Steps Culturally Effective Health Care online course
- Texas Health Steps Additional Courses
- Texas Health Steps Provider Information
- Texas Health Steps Regional Representative Contact List
- Texas Medicaid/CHIP Vendor Drug Program
- Texas Medicaid & Healthcare Partnership
Member Rights and Responsibilities
Clinical and Administrative Advisory Committee, Behavioral Health Advisory Committee, Perinatal Advisory Committee
These Provider Advisory Groups provide recommendations to Texas Children’s Health Plan in the following areas:
- Identification and review of clinical practice guidelines and prior authorization guidelines;
- Review of general utilization patterns and assessment of Provider compliance with clinical guidelines;
- Recommendations for member engagement and quality improvement programs to improve health outcomes and keep members healthy
- Strategies and recommendations for improving Health Plan administrative processes;
- Recommendations on how to improve care based on Member feedback and their personal experiences serving our Members; and
- Opportunities for connecting network Providers and Managed Care Organization clinical experts for purposes of peer support and sharing best practices.
There is a Clinical and Administrative Advisory Committee for each of our three Service Areas:
- Harris
- Jefferson
- Rural Service Area Northeast
The Behavioral Health Advisory Committee and Perinatal Advisory Committee meet in the Harris Service Area.
The meeting cadence for each of the committees are as follows:
- Clinical and Administrative Advisory Committee meets 9 times per year in the Harris Service Area and quarterly in the Jefferson and Rural Service Area Northeast
- Behavioral Health Advisory Committee meets quarterly
- Perinatal Advisory Committee meets quarterly