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otherwise, a decision is made based on previously received information.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},283936,1790209152,{"code":4,"msg":82,"data":83},"success",[84,89,94,99,104,109,113,118,123],{"id":85,"doc_module":22,"doc_module_name":25,"category_name":86,"show_sort_weight":87,"slug":88},11,"Presentations",90,"presentations",{"id":90,"doc_module":22,"doc_module_name":25,"category_name":91,"show_sort_weight":92,"slug":93},12,"Resumes",80,"resumes",{"id":95,"doc_module":22,"doc_module_name":25,"category_name":96,"show_sort_weight":97,"slug":98},14,"Invoices",70,"invoices",{"id":100,"doc_module":22,"doc_module_name":25,"category_name":101,"show_sort_weight":102,"slug":103},15,"Posters",60,"posters",{"id":105,"doc_module":22,"doc_module_name":25,"category_name":106,"show_sort_weight":107,"slug":108},16,"Social Media",50,"social-media",{"id":110,"doc_module":22,"doc_module_name":25,"category_name":29,"show_sort_weight":111,"slug":112},17,40,"forms",{"id":114,"doc_module":22,"doc_module_name":25,"category_name":115,"show_sort_weight":116,"slug":117},18,"Letters",30,"letters",{"id":119,"doc_module":22,"doc_module_name":25,"category_name":120,"show_sort_weight":121,"slug":122},21,"Paper Templates",5,"papers-templates",{"id":124,"doc_module":22,"doc_module_name":25,"category_name":125,"show_sort_weight":4,"slug":126},158,"General","general-158",{"code":4,"msg":82,"data":128},{"doc_id":79,"user_id":129,"nickname":42,"user_avatar":130,"doc_module":22,"category_id":110,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":22,"language":136,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":12,"update_tm":140,"read_time":4},2336474466712,"https://ap-avatar.wpscdn.com/davatar_a8503ba1806abce46bf441b54a3ca4cd","Prior Authorization Procedures and Requirements  \nTexas Children’s Health Plan requires the completed Texas Standard Prior Authorization Form with the following information:  \n􀁸 Member Name  \n􀁸 Member Date of Birth  \n􀁸 Member Medicaid/CHIP Identification Number  \n􀁸 Requesting Provider Name and National Provider Identifier (NPI)  \n􀁸 Requested Service  \n􀁸 Current Procedures Terminology (CPT) Codes Requested  \n􀁸 Number of Units Requested  \n􀁸 Dates of Service  \n􀁸 Adequate Supporting Clinical Documentation  \nSupporting Clinical Documentation for Incomplete Prior Authorization Requests:  \nPrior authorization requests must include complete and sufficient clinical information. Prior  Authorization Determinations  \nWhen Texas Children’s Health Plan (TCHP) receives a request for prior authorization for a service, and the request does not provide enough clinical information or supporting documentation for us to determine if these services are medically necessary, TCHP will:  \nSend the Medicaid provider a letter describing the specific documentation that needs to be submitted, and  \n􀁸 When possible, TCHP will contact the Medicaid provider by telephone and obtain the information necessary to complete the prior authorization process.  \n􀁸 The member will receive a written notice of the request for submission for the incomplete clinical information that was sent to the provider.  \nProviders must supply the requested clinical information/documentation within three  \n(3) business days after the date of the TCHP letter.  \nIf the clinical information/documentation is not received within the required timeframe, we will make a decision regarding the requested services based on the information previously received.  \nThe requested clinical information should be sent to Utilization Management.  \nPrior Authorization Fax Lines  \n􀁸 Medical Inpatient Admissions and Discharge Notifications-832-825-8462 or Toll-Free 844-663-7071  \n􀁸 Medical Services Fax Line-832-825-8760 or Toll-Free 1-844-473-6860  \n􀁸 Behavioral Health Services Fax Line-832-825-8767 or Toll-Free 1-844-291-7505  \n􀁸 LTSS and Private Duty Nursing Fax Line-346-232-4757 or Toll-Free 1-844-248-1567  \n􀁸 Post Hospital Discharge Authorizations Fax Line-Toll-Free 866-839-9879  \nUtilization Management provides written notice of the determination of approval or denial of the prior authorization request within three business days after receipt of a complete prior authorization request.  \nRevised on 9/7/2023","cbCainSCfCBaHj2T","https://ap.wps.com/l/cbCainSCfCBaHj2T","pdf",240901,"English","# Prior Authorization Procedures and Requirements\n## Required Information on the Texas Standard Prior Authorization Form\n## Supporting Clinical Documentation for Incomplete Requests\n## Prior Authorization Determinations and Response Timelines\n## How and Where to Send Clinical Information\n## Prior Authorization Fax Lines","[{\"question\":\"What information must be included on the Texas Standard Prior Authorization Form?\",\"answer\":\"Include member name, date of birth, Medicaid/CHIP identification number, requesting provider name and NPI, requested service, requested CPT codes, number of units, dates of service, and adequate supporting clinical documentation.\"},{\"question\":\"What happens if the prior authorization request is incomplete?\",\"answer\":\"Texas Children’s Health Plan sends a letter describing the specific documentation needed, may contact the provider by telephone to obtain information, and issues a written notice to the member requesting submission of the missing clinical information.\"},{\"question\":\"How quickly must providers submit the requested clinical documentation?\",\"answer\":\"Providers must supply the requested clinical information/documentation within three (3) business days after the date of the TCHP letter; otherwise, a decision is made based on previously received information.\"}]","Texas Standard Prior Authorization Procedures and Requirements - Revised on 9/7/2023 | PDF",1789622840]