Quick Reference Guide

For a printable PDF of our Provider Quick Reference Guide, please click here.

Customer Service

Claim inquiry, questions, and information.
Information about CHIP or STAR products.
Eligibility/benefits questions on all products.

Phone: 832-828-1004
Toll free: 1-800-731-8527
Telephone TouCHPoint: 832-828-1007
Fax: 832-825-8750

Texas Children’s Health Plan Fraud and Abuse

Suspected fraud, waste or abuse (FWA) by recipients or providers can be reported to the Office of Inspector General (OIG) and/or Texas Children’s Health Plan’s Special Investigations Unit (SIU). Texas Children’s Health Plan’s Fraud, Waste, and Abuse Hotline is a dedicated resource designed specifically for our Network Providers. We understand the critical importance of maintaining the highest standards of integrity and compliance within our healthcare network. The hotline is 866-828-4924, or visit https://tchpintegrity.com/.

You can reach Texas Children’s Health Plan Controls and Compliance Department at 832-828-1320
Fax Number: 832-825-8722
Email: TCHPSIU@texaschildrens.org

Office of Inspector General: FWA Reporting
Website: https://oig.hhsc.texas.gov/report-fraud-waste-or-abuse

Provider Relations

Monday - Friday 8:00 a.m. - 5:00 p.m. Contact us for:

Updates to provider demographic information
Requests for supplies (forms, directories, etc.)
Requests for information on accessing Provider TouCHPoint
Texas Children’s Health Plan’s web-based provider portal, Texas Children’s® Link
Request for educational in-services, CME, and educational material
Concerns with Texas Children’s Health Plan Policies and Procedures

Phone: 832-828-1004
Toll free: 1-800-731-8527
Fax: 832-825-8750
Email: providerrelations@texaschildrens.org

Email: providerrelations@texaschildrens.org

Texas Children’s Health Plan Pharmacy Information

Navitus website: www.navitus.com
Navitus toll free provider hotline: 1-877-908-6023
Navitus customer care: 1-866-333-2757

Provider Portal, Texas Children’s® Link

Texas Children's® Link is a web-based provider portal for contracted providers that allows secure, convenient 24-hour access to our member’s information. Through the portal, you can view a Texas Children’s Health Plan member’s eligibility, check the status of your claim, submit an authorization, look up an explanation for CPT, diagnosis, or modifier codes, and more. Click here to learn more.

Password Resets: TCHP strongly encourages you to set up your challenge questions when you first log in to the provider portal. If you forget your password, you’ll be able to reset the password yourself by answering those questions that you’ve previously set up. If your password expires due to non-use for 90 days or you need a password reset, please call TCHP at 832-828-1004. The representative will document needed information for our IS team and then send the information over so your password can be reset within the next 24 to 48 hours.

For a new account: Click here
Only one registration form is necessary per office.
For further assistance, email Provider Relations at ProviderRelations@texaschildrens.org

Cultural Sensitivity

Please visit our Cultural Competency page to learn more.

Envolve Vision

CHIP: 1-844-520-3711
STAR: 1-844-683-2305
STAR Kids: 1-844-212-7269

Dental Services

DentaQuest (STAR): 1-800-516-0165
DentaQuest (CHIP): 1-800-508-6775
MCNA Dental: 1-800-494-6262

Texas Children’s Health Plan value added benefit:
FCL Dental (STAR members over 21): 1-866-548-8123

Care Coordination, Case, and Disease Management

Referrals for assistance with chronic, complex conditions, or maternity. Requests for birthing and health education classes.

Phone: 832-828-1430
Fax: 832-825-8745

Asthma / Obesity / Diabetes education:

Phone: 832-828-1004
Fax: 832-825-8705

Nurse-Family Partnership:

Phone: 832-828-1274
Fax: 832-825-8710

24-Hour Nurse Help Line

Members have access to registered nurses 24 hours a day, 7 days a week.

Texas Children’s Health Plan Nurse Help Line: 1-800-686-3831

Claims Filing Information

Filing deadlines for all products is 95 days from date of service.

Texas Children’s Health Plan Claims
PO Box 300286
Houston, TX 77230-0286

Claims Appeals

All appeals must be received within 120 days from the previous health plan Explanation of Payment (EOP). Please use the appeal coversheet from Texas Children’s Health Plan Provider Manual.

Texas Children’s Health Plan
Attn: Appeals
PO Box 300286
Houston, TX 77230-0286

Prior Authorizations

Please visit our Prior Authorization Information page for more information.

Referrals

Patients should be referred to in-network specialists. When Texas Children’s Health Plan members are referred for specialty care to an in-network specialist, it is not necessary to complete a referral form. Members may self-refer for in-network OB/GYN services, behavioral health, family planning, and any Texas Health Steps provider.

Imaging Services

It is not necessary to use a referral form for imaging services. Providers should refer members for imaging services.

Laboratory Services

Providers should refer members for laboratory services to an in network labs or State of Texas Laboratories. Some laboratory services may require prior authorization.

Phone Numbers for State Programs

CHIP Help Line: 1-800-647-6558
Early Childhood Intervention (ECI): 1-877-787-8999, select language, then select option 3
Texas Health Steps: 1-877-847-8377
Women, Infants & Children Program (WIC): 1-800-942-3678
Vaccine for Children (VFC): 1-800-252-9152, select option 1, then select language

Behavioral Health Hotline

STAR: 800-731-8529
CHIP: 800-731-8528
STAR Kids: 1-844-818-0125