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COVID Flexibility, Waiver of Prior Authorization Requirements for out-of -network PCP Visits
Date: December 23, 2024
Attention: Primary Care Providers, Family Practice, General Practice, Internal Medicine, OG/GYN
Effective date: March 22, 2025
Call to action: This communication is to serve as notice that Texas Children’s Health Plan (TCHP) will change the prior authorization (PA) requirements for out-of-network (OON) primary care provider (PCP) visits. Effective for dates of service on or after December 31, 2024 a prior authorization will be required for OON PCP visits.
If a member would like to find an in-network provider, please direct them to our online “Find a Provider” directory available here, https://www.texaschildrenshealthplan.org/find-a-provider.
Member Services can be contacted for further assistance:
- CHIP: 832-828-1002 (local), 1-866-959-6555, TTY 800-735-2989 (Texas Relay) or 7-1-1
- STAR: 832-828-1001 (local), 1-866-959-2555, TTY 800-735-2989 (Texas Relay) or 7-1-1
- STAR Kids: 832-828-1003 (local), 1-800-659-5764, TTY 800-735-2989 (Texas Relay) or 7-1-1
- STAR Kids members can reach their service coordinator 800-659-5764.
The hours are 8 a.m. to 5 p.m. CST, Monday through Friday.
Background information: TCHP continued this COVID flexibility of not requiring a PA beyond the Health and Human Services time frame of May 11, 2023, however must discontinue the flexibility on December 31, 2024.
Next step for Providers: At the time of scheduling an appointment, providers should verify that their patient is an active TCHP Member. Or secure a prior authorization before the appointment date.
If you have any questions, please email Provider Relations at:providerrelations@texaschildrens.org.
For access to all provider alerts: https://www.texaschildrenshealthplan.org/providers/provider-news/provider-alerts.