Provider Alert! Governor Abbott Declares State of Disaster In Texas Due To COVID-19
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.
To inquire about becoming a contracted provider please complete a Letter of Interest form and submit a W-9.
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
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).
Hospitals Billing Neonatal Claims Must Submit Application for Neonatal Level of Designation before July 1, 2018
Effective immediately, hospitals rendering neonatal services must submit their neonatal designation applications to the Texas Department of State Health Services.
- Completed applications must be submitted before July 1, 2018.
- Applications received after July 1 will not be considered for approval. If an application is received after July 1, it will not be considered as submitted in time for approval by the executive commissioner before the August 31 deadline.
- Each hospital provider location is considered separately for designation.
There is no grace period for Medicaid reimbursement payments if a facility is not designated.
For additional information, application information and Texas Administrative Code, Title 25, Chapter 133, Subchapter J, please click here
New Vision Services Provider
Effective April 1, 2018, Envolve Vision will provide routine vision services for all members. If you have any questions about vision benefits, please call Envolve Vision. The following toll-free numbers apply to both providers and members.
STAR Kids: 1-844-212-7269
Hurricane Harvey Update
Effective August 25, 2017, Pharmacy and Provider copays will be waived for members in the FEMA declared disaster counties.
Visit HHSC's website Hurricane Harvey Information for Providers
Updated - Hurricane Harvey Medicaid and Children's Health Insurance Program (CHIP) Frequently Asked Questions for Managed Care Organizations (MCOs)
Medicaid Fraud Notice
Effective 09/01/2017 Adoption Assistance members are required to enroll in managed Medicaid and will be new members with Texas Children’s Health Plan STAR or STAR Kids programs.
STAR Kids Billing Matrix
The STAR Kids billing matrix has been updated to include the registered nurse modifier (TD) to the private duty nursing (PDN) billing code, T1000. Additionally, the billing codes for PDN independently enrolled LVNs and RNs have been added to the matrix. The Revenue Code 663 was added to the Out-of-Home Respite codes. Attached is the updated billing matrix, which will be added to the handbook. This billing matrix will become effective on June 5, 2017.
Effective April 1: EVV Compliance Score Must be 90%
Beginning April 1, 2017, providers required to use Electronic Visit Verification (EVV) will be required to meet the minimum EVV compliance score of 90% as outlined in the EVV Provider Compliance Plan. Providers were required to meet the minimum score of 75% for the first year of compliance from April 1, 2016, through March 31, 2017. Questions about this alert can be sent to: firstname.lastname@example.org
Texas Health Steps Regional Representative Contact List
THSteps Documentation Improvement
As a Texas Health Steps (THSteps) provider, you affect the lives of many young Texans, and the Health and Human Services Commission (HHSC) understands documenting the THSteps components of the checkup can be challenging. One federal and two state contracted reviews of medical records have shown that missing documentation is the largest factor and the primary cause of records being reviewed and money being recouped. HHSC would like to assist you in documenting all of the required components and elements of the THSteps checkups in order to reflect the work you perform to complete each checkup. | read more...
Patient Protection And Affordable Care Act Deadline Has Passed And Dis-enrollment From Texas Medicaid Will Occur January 31, 2017
The Patient Protection and Affordable Care Act (PPACA) requires providers to have revalidated their enrollment in state Medicaid programs by September 24, 2016. In accordance with PPACA and based on direction from the Texas Health and Human Services Commission (HHSC),TMHP has accepted and is processing completed revalidation applications received by September 24, 2016. | read more...
THsteps Checkup Documentation -- Essential to Medical Records
As a Texas Health Steps (THSteps) provider you affect the lives of many young Texans. The care you provide helps prevent serious or chronic health-care problems and often helps young patients begin to develop positive lifelong health-care habits. Being a THSteps provider can be very rewarding. It can also be very challenging, especially when it comes to medical checkup documentation. | read more...