On April 18, 2019: Governor Greg Abbott issued a disaster declaration for the following counties Cherokee, Freestone, Houston, Leon, Madison, Nacogdoches, Robertson, San Augustine, and Shelby counties. If a member resides in one of these impacted areas named above Texas Children’s Health Plan will make every effort to assist them in obtaining medically necessary services.
PHARMACY: Navitus Pharmacy update related to disaster declaration:
Navitus has implemented the "Disaster Declaration and Refill Too Soon" process as a result of the severe weather, including thunderstorms and tornado events in the State of Texas. As part of our process the Refill Too Soon (RTS) rejects have been lifted so that members who are affected are able to access their medications without disruption. As part of invoking this process, the RTS edits are lifted at a member zip code level so if a member resides in an affected zip code they can go to any pharmacy in our service area (even out of their home state) and obtain medications without having to receiving a rejection. These RTS edits are lifted for the timeframe of April 12, 2019 to May 12, 2019. These edits are currently lifted for all lines of business.
Additional information will be posted as it becomes available.
Portal Use for Non-Contracted Providers
Texas Children’s Health Plan has a commitment to provide maximum security of member information, and a pledge to adhere to HIPAA privacy guidelines. Beginning September 1, 2018, we discontinued the access for non-contracted providers to the online provider portal. For non-contracted providers that currently have access, as your account is due for renewal, access will not be renewed. We apologize for any inconvenience this may cause. You may contact the Provider hotline at 832-828-1008 or Toll free: 1-800-731-8527.
The Texas Children’s Health Plan Network Management Department will review to ensure the following criteria are met:
Provider is a Texas Medicaid Provider, as applicable
Provider delivers service in one of the Texas Children’s Health Plan service areas
Provider has admitting privileges at a participating hospital within Texas Children’s Health Plan’s provider network, as applicable
Service provided is an identified network need for Texas Children’s Health Plan
Provider Notification: Credentialing Using Availity
April 1, 2018, Texas Children’s Health Plan is now using Availity, a credentialing application portal, for implementation of the Credentialing Verification Organization (CVO).
On April 12, a webinar training will be offered to providers to instruct on the new credentialing process using he Availity portal. This training is for providers who have already registered with Availity, and will be an in-depth training on how to use the Credentialing tool.
Instructions to Enroll in Training Webinar:
To enroll for the Credentialing on the Availity Portal webinar training on April 12, 2018 at 3:00 p.m. CT:
If not yet registered for Availity, go to www.Availity.com, click Register in the top right of the page, then follow the organization registration process. Once your registration is approved you can proceed to the next step.
To enroll for the April 12, 2018 live webinar, Credentialing on the Availity Portal for TAHP Providers, click here then log in to your Availity account. A separate tab will open directly on the enrollment page for this webinar. Click Enroll at the top right of the page.
Once enrolled, you will receive a confirmation email as well as a reminder email prior to the event.
How to update member information if they have moved:
All address changes must be reported to HHSC. Members can contact HHSC by calling 2-1-1 or by updating their account on YourTexasBenefits.com.
It is important to make sure address information is updated in a timely manner to ensure families continue to receive information from Texas Children’s Health Plan and HHSC. If a member has moved to an area that is not covered by Texas Children’s Health Plan they will need to select a new health plan. If a family is unsure if they have moved to an area that is outside of Texas Children’s Health Plan’s service area, we can help them by connecting them to HHSC so the address change can be made. Members will continue to have access to care through Texas Children’s Health Plan until HHSC changes their address.
If a Member needs help, call Member Services toll-free at 1-866-959-2555 (STAR), 1-866-959-6555 (CHIP), or 1-800-659-5764 (STAR Kids).
As a Texas Children’s Health Plan provider, we value your role in providing quality health care to our members, your patients. Our role as a health plan is to provide you with the tools and resources you need to be successful as efficiently and productively as possible. Texas Children’s Health Plan offers solutions and new technologies that save you time so that you can better serve your patients.
We will keep you updated as new technologies become available. Check our Provider Resources page periodically to stay up-to-date on the latest resources available to you. To learn more, call our provider relations department at 832-828-1008 or toll-free at 1-800-731-8527.
Our website for providers is designed as a tool to help you. You can find an array of resources such as: