Guidance on Electronic Claims Submission

Date: November 19, 2024

Attention: All Providers

Background information: At Texas Children's Health Plan (TCHP), we’re committed to making your claim submission experience as smooth and efficient as possible. One of the most effective ways to improve this process is by switching from submitting paper claims to electronic claims. 

Why Submit Claims Electronically?

• Faster Payments: Electronic submissions are processed more quickly, meaning you can expect faster reimbursement for your services.
• Reduced Errors: Electronic claims help minimize manual data entry mistakes that can lead to claim denials or delays.
• Real-Time Claim Status: Check the status of your claims instantly through the provider portal, Texas Children's^® Link, giving you more control and reducing the time spent waiting for updates.
• Environmentally Friendly: Going paperless supports sustainability by reducing paper usage.
• Improved Efficiency: Electronic submissions save time, reduce paperwork, and allow you to focus on patient care instead of administrative tasks.

How to Submit Claims Electronically

Option 1: The most efficient option is submitting claims and appeals through Texas Children's^® Link, our provider portal: https://epiccarelink.texaschildrens.org/

• Single claim submission is available on the portal. Just search your patient, select the appropriate claim form, fill out all relevant claim information, and click submit. 
• The batch claim submission process is available on the portal, where 837 files can be uploaded directly onto Texas Children's® Link.
  • To access this from Texas Children's® Link, go to External Sites > TCHP Provider Tools > TCHP Batch Claims
• If you do not already have a Texas Children's® Link account, you can request an account by visiting https://www.texaschildrenshealthplan.org/providers/link-provider-portal
• If you need any aid with submitting claims, navigate to the User Guide within the Texas Children's Health Plan Portal Resources section in the provider portal. 

Option 2: If you are already using Availity as your clearinghouse, submitting claims is just as easy – claims will automatically route to TCHP using the proper payer IDs. No additional setup is required.

• For payer ID details, consult the TCHP Institutional Guideand TCHP Professional Guide.
• Not yet enrolled with Availity?Register hereand get started with their user-friendly platform for electronic claims submission.
• For more information about Availity, you can view their training site.

Option 3: TexMedConnect is a free, web-based claims submission application provided by Texas Medicaid & Healthcare Partnership (TMHP). Technical support and training for TexMedConnect are also available free from TMHP. Providers can submit claims, eligibility requests, claim status inquiries, appeals and download ER&S Reports using TexMedConnect. TexMedConnect can interactively submit individual claims that are processed in seconds. 

How to Check Your Claim Status

Whether you're using Texas Children's® Link, Availity, or TexMedConnect, checking the status of your claims is simple:

• Texas Children’s® Link: Login to the portal to view claim statuses at https://epiccarelink.texaschildrens.org/.
• No Portal Access? You can still check claim statuses as a guest: Claim Status Lookup.
• By Phone: Call our TouCHPoint team at 832-828-1007 for assistance.

Get Started Today!

The transition to electronic claims is easy and can start as soon as you have access to Texas Children's® Link. By submitting claims electronically, you’ll save time, reduce errors, and receive faster reimbursement.

If you need assistance with setting up your account or have any questions, don’t hesitate to reach out to us at providerrelations@texaschildrens.org. 

If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org

For access to all provider alerts,log into: www.texaschildrenshealthplan.org/provideralerts