COVID-19 Updates
Learn MoreAs a Dell Children’s Health Plan provider, we value your role in providing quality healthcare to your patients, our members. Our role as a health plan is to provide you with the tools and resources you need to be successful.
If you cannot find what you need here on our website, please get in touch. You can contact our Provider Engagement Department by email.
Provider Portal
LoginImportant Phone Numbers
- Behavioral Health Care: 888-821-1108
- Disease Management Department: 888-830-4300
- Member Services: 888-596-0268 TTY 711
- Navitus (Pharmacy Benefit Manager): 877-908-6023
- Provider Services (Claims Status, Eligibility & Benefits): 888-821-1108
- Monday through Friday from 7 a.m. to 7 p.m. Central time
- Provider Relations Department: 512-324-3125
- Superior Vision of Texas: 800-879-6901
- Utilization Management Department: 888-821-1108
Please click here if you would like to become a provider with us.
Important Links
- Members Rights and Responsibilities
- My Diverse Patients
- Texas Medicaid & Healthcare Partnership
- Texas Health and Human Services Commission
- Texas Medicaid/CHIP Vendor Drug Program
Pharmacy
- Navitus Health Solutions
- Navitus MAC Pricing
- Texas Medicaid/CHIP Vendor Drug Program – Formulary Information
- Texas Medicaid/CHIP Vendor Drug Program – Preferred Drugs
- Texas Vendor Drug Program – Clinical Prior Authorization Criteria
Prior Authorizations
- ICR – Online UM Tool
- Precertification Look-Up Tool Outpatient (PLUTO)
- Medicaid and CHIP Precertification Effective Dates
- Prior Authorization Annual Review Report SFY2021
- Pharmacy Authorizations
- Prior Authorization Requirements
- Prior Authorization Forms
Provider Notices and Reminders
- 2021 Affirmative Statement Concerning Utilization Management Decisions
- Admission, Discharge & Data transfer results in improved care management
- Availity Portal eligibility and benefits (Additional benefit notes and digital member ID Cards)
- Clinical Criteria Updates Notification December 2020
- Clinical Criteria Updates Notification February 2021
- Clinical Criteria Updates Notification June 2021
- Clinical Criteria Updates Notification March 2021
- Clinical Criteria Updates Notification November 2020
- Clinical Practice Guidelines Matrix
- Diabetes testing and screening HEDIS measures
- EnrollSafe will replace CAQH Enrollhub® as the electronic funds transfer (EFT)
- February 2021 Clinical Utilization Management (UM) Guidelines
- February 2021 Medical Policies and Utilization Management Guidelines update
- Federally qualified health centers and rural health clinic modifier requirements
- HB1576 Implementation of Nonemergency Medical Transportation
- HEDIS 2020: Medicaid Measure Update and Summary of Changes from NCQA
- HEDIS measures: Follow-Up After ED Visits for Mental Illness and Alcohol and Drug Dependency
- Important update: behavioral health fax numbers changing
- Keeping up with routine vaccinations during COVID-19
- Let’s Vaccinate
- May 2021 Medical Policies and Utilization Management Guidelines update
- MCG Care Guidelines 24th edition customization
- MCG Care Guidelines 25th Edition
- New claim submission requirement for durable medical equipment delivery verification
- Nonemergency medical transportation changes effective June 1, 2021
- November 2020 Clinical Utilization Management (UM) Guidelines update 2/22/21
- November 2020 Medical Policies and Utilization Management Guidelines update 2/12/21
- Metabolic monitoring and diabetes screening measures for those on antipsychotics medications
- Specialty Rx Precertification Additional Documentation Notice effective August 1, 2021
- Updates to the AIM Advanced Imaging Clinical Appropriateness Guidelines
- Voluntary recall of Philips Respironics CPAP machine, BiPAP machine, and ventilator
- What Matters Most: Improving the Patient Experience
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- 2020 affirmative statement concerning utilization management decisions
- Acquisition of Beacon Health Options
- August 2020 Clinical Utilization Management (UM) Guidelines
- August 2020 Medical Policies and Utilization Management Guidelines update
- Availity Provider FAQ
- Change Healthcare Medical Attachment Functionality FAQ
- Clinical Criteria Web Posting September and October 2020
- Clinical Edit Form for Symdeko
- Clinical Edit Form for Taltz
- Consumer Assessment of Healthcare Providers and Systems® (CAHPS) 101
- Controlling High Blood Pressure (CBP)
- Emergency Room Autopay List of Diagnosis Codes
- February 2020 Clinical Utilization Management (UM) Guidelines Update
- February 2020 Medical Policies and Clinical Utilization Management Guidelines update
- Global 3M19 Medical Policy and Technology Assessment Committee Prior Authorization Requirement Updates
- HealthyTexasWomen
- Incentive delay notice
- Incorrect Claims Payments Alert
- LARC Devices Reminder
- May 2020 Clinical Utilization Management (UM) Guidelines Update
- May 2020 Medical Policies and Clinical Utilization Management Guidelines update
- MCG care guidelines — 24th edition
- MCS Notification of Delivery Form
- Medical Drug Benefits Clinical Criteria Updates (February 2020)
- Medical Drug Benefits Clinical Criteria Updates (March 2020)
- Medical Drug Benefits Clinical Criteria Updates (May 2020)
- Medical Drug Benefits Clinical Criteria Updates (June 2020)
- Medical Drug Benefits Clinical Criteria Updates (August 2020)
- New Baby, New Life Provider Booklet
- New behavioral health discharge call-in line
- New Emergency Room Requirement for Hospital and Autopay List of Diagnosis Codes
- New MCG Care Guidelines 24th edition Viral Illness
- November 2019 Medical Policies and Clinical Utilization Management Guidelines update
- OBGYN Ultrasound Update
- Policy Reminder – Nurse Practitioner and Physician Assistant Services, Professional
- Prenatal Ultrasound Diagnosis Codes
- Preventative Health Guidelines- English
- Preventative Health Guidelines- Spanish
- Prior authorization requirements for angiographic evaluation of stenotic or thrombosed dialysis circuits
- Prior authorization requirements for E0482
- Provider Digital Engagement
- Providers using Change Healthcare can now receive and respond to medical record requests for postpay audit via the Assurance Attach Assist Module
- Racial Trauma Forum Invitation
- Submit behavioral health authorizations via our online Interactive Care Reviewer tool
- Texas Health Steps and extended ophthalmoscopy
- Transition to AIM small joint guidelines
- TX Dell Children Availity Provider Article
- Updates to AIM Clinical Appropriateness Guidelines for Advanced Imaging
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- August 2019 Clinical Utilization Management (UM) Guidelines Update
- Changes to Mental Health Rehabilitative Services and Targeted Case Management Prior Authorization/Notification Requirements
- Clinical Criteria Web Posting July 2019
- Clinical Criteria Web Posting Q2 2019
- Clinical Criteria Web Posting September 2019
- Clinical Criteria Web Posting November 2019
- Clinical Criteria Web Posting December 2019
- Clinical Edit Form for Emflaza
- Clinical Edit Form for Emgality
- Clinical Edit Form for Synagis
- Clinical Edit Form for Tadalafil
- Clinical Edit Form for Victoza
- Clinical Laboratory Improvement Amendments
- Clinical Practice Guidelines and Preventive Health Guidelines-Update
- Clinical Practice Guidelines Matrix
- Coding tip for psychological and neuropsychological testing
- Disease Management can help you care for patients with chronic health care needs
- EDI Gateway Migration
- Enhanced Claim Payment Dispute Process
- Guidelines Update for Therapy Precertification Requests
- Healthy Rewards Provider Flier
- Medicaid Span of Coverage
- Medical Policies and Clinical Utilization Management Guidelines Update
- New Clinical Guideline: Pneumatic Compression Devices
- November 2019 Clinical Utilization Management (UM) Guidelines Update
- P4Q Provider Incentive Plan
- Prenatal Aspirin for the Prevention of Preeclampsia
- Prepayment Clinical Validation Review Process
- Prior Authorization Requirements Changes Effective November 1, 2019
- Prior Authorization Form for Emflaza
- Prior Authorization Form for Emgality
- Prior Authorization Form for Symdeko
- Prior Authorization Form for Synagis
- Prior Authorization Form for Tadalafil
- Prior Authorization Form for Taltz
- Prior Authorization Form for Victoza
- Prior Authorization Requirements for Interferon beta-1a
- Prior Authorization Requirements for Subcutaneous Implantable Defibrillator System
- Prior Authorization Requirements for Sublocade
- Prior Authorization Requirements for Somatrem
- Prior authorization requirements: new 2020 codes for coverage and precertification
- Prior Authorization Update for Physician Order Requirements
- Sports Physical and Annual Checkups
- Utilization Management Affirmative Statement concerning utilization management decisions
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- 2018 Utilization Management Affirmative Statement
- Adoption Assistance or Permanency Care Assistance Managed Care Expansion
- Category II HEDIS Coding Tips
- Chimeric antigen receptor T-cell therapy requires prior authorization for all places of service
- CHIP Copay Changes
- CHIP Formulary Prior Auth Implementation – November
- CHIP Formulary Prior Auth Implementation – December
- Custom Shower Chairs Prior Authorization
- Dell Children’s Health Plan adopts Milliman Care Guidelines
- Eight Injectable Drugs Will Require Prior Authorization
- Electrical Stimulation Device to Require Prior Authorization
- Electronic Data Interchange Gateway Update
- Electronic Data Interchange (EDI) Update
- Elotuzumab to Require Prior Authorization
- Guidelines Update for Processing Therapy Precertification Requests
- January 2018 Medical Policies and CUMG Updates
- Lower extremity vascular intervention codes require prior authorization
- March 2018 Medical Policies and CUMG Updates
- Member Appeal Process Changes Notice to Providers
- Medical Policies and Clinical Utilization Management Guidelines – January 2018
- Medical Policies and Clinical Utilization Management Guidelines – March 2018
- Medical Policies and Clinical Utilization Management Guidelines update – May 2018
- Medical Policies and Clinical Utilization Management Guidelines Update – November 2018
- Miscellaneous Durable Medical Equipment Billing Guidelines
- Neonatal Level of Care Designation Required
- Non-Emergency Ambulance Prior Authorization Update
- Normal Newborn Diagnosis-Related Group Claims Processing Update
- Notification of Joint Venture
- Overpayment Identification and Refund Requirements
- P4Q Provider Incentive Plan
- Post-Payment Reviews of Distinct Procedural Service Modifiers
- Prenatal and Postpartum Outreach Initiatives
- Prior Authorization Requirement Update for Mylotarg
- Prior Authorization Requirements for Cabazitaxel
- Prior Authorization Requirements for Darzalex Drug
- Prior Authorization Requirements for Injectable/Infusible Drugs: Mepolizumab (Nucala) and Reslizumab (Cinqair)
- Services Requiring Prior Authorization
- Spinraza Clinician-Administered Drug Prior Authorization Requirements
- Update Regarding Appointment Availability Standards
- Update to Ordering/Prescribing/Referring Claim Submissions
- What Matters Most: Improving the Patient Experience CME
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HHSC Notifications
- HHSC Off Cycle MCO Notice 01.04.2021
- HHSC New HTW Provider Certification Requirements 04.26.2021
- Hurricane Ida Provider Assistance FAQ
- Public Health Emergency Enrollment Application Will No Longer be Available for Use
- Texas Medicaid Guidance in Response to Philips Recall of Respiratory Device
- What Matters Most: Improving the Patient Experience
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- Addition of Bamlanivimab as Texas Medicaid Benefit
- Healthy Texas Women Plus
- Healthy Texas Women (HTW) Plus Services Available September 1, 2020
- Help Youth Formerly in Foster Care Maintain Their Medicaid
- How to Submit a Complaint as a Medicaid Provider
- Hurricane Delta and Laura Information for Medicaid Providers
- Learning Opportunity Pediatric Brain Health Summit on November 5-6 2020
- Services Not Covered in the Texas Medicaid State Plan
- Survey to Identify Substance Use Screening and Referral Practices for Pregnant and Postpartum Women
- Telemonitoring Benefit Changes for Texas Medicaid
- Training Module Immunization
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- CS Health Advisory Notice
- Data Quality Issues Experienced by MCOs via Texas Immunization Registry
- Delegated Psychological Services
- DSHS Laboratory Request Form
- DSHS Laboratory Web Portal Notice
- Opioid Treatment Providers
- Smoking and Tobacco Use Cessation Counseling Benefits Change
- Summary of Tobacco Cessation Benefits
- Tobacco Use Cessation Services Provided in a Group Setting
- Updated American Dental Association Claim Form
- Webinar on Writing Functional Therapy Goals
- Updated Version of the American Dental Association Claim Form
- Zika Virus Testing Update
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- 10-4-17 Upcoming CHIP Provider Enrollment Webinar
- 2018 Mosquito Repellent Standing Order
- AIM Maternal Safety Bundles n Texas Informational Sheet
- Benefit Update for Early Childhood Intervention for Texas Medicaid
- Breast Pump Notification Sept. 2017
- CHIP Member Eligibility EDI 270/271 Training
- CHIP Texas Medicaid & Healthcare Partnership Enrollment Notice
- Complete Rate Changes and Updates for Medicaid Therapy Services Eff 09.01.17
- Delayed Implementation for Required NPI of Rendering Provider
- HHSC Guidance on the Provision of Therapy
- HHSC Guidance on the Provision of Therapy Update (Clarification)
- HHSC Notice for Therapy Services
- HHSC Therapy Notification Update
- Hurricane Harvey – CHIP Copayments Notice
- Hurricane Harvey- Frequently Asked Questions
- Mayo Clinic Diversity Summit Flyer
- Mayo Pathways Diversity 2018
- Medicaid Fraud Letter to Providers
- Medicaid Fraud Provider Notice
- Mental Health Screening THSteps
- Neonatal Billing Requirements
- New Definition of Individual Speech Therapy Encounter
- Notice to Pharmacies: Mosquito Repellent Benefit
- Notice to Prescribers: Mosquito Repellent Benefit
- Prenatal Screening for Domestic Violence and Substance Abuse
- Postpartum Depression Screening THSteps
- Private Duty Nursing Benefit Language Clarified for Texas Medicaid
- Provider Types and Places of Service Changes for Physical, Occupational and Speech Therapy for All Ages for Texas Medicaid Sept. 1
- Special Supplemental Nutrition Program for Women, Infants and Children (WIC)
- Telemedicine and Telehealth Services Benefit Policy Language Update
- Texas AIM Flyer March Webinar
- Texas Health Steps Clinical Record Review Tool
- Texas Health Steps Clinical Record Review Tool – Alternate Version
- Texas Health Steps Improvement Letter
- Texas Health Steps Regional Provider Relations Representatives Contact List
- Texas Health Steps Therapeutic Dental Benefits Change Notice
- Third Party Liability and Recovery Guidance
- THSteps Therapeutic Dental Benefits to Change for Texas Medicaid July 1, 2017
- THSteps Therapeutic Dental Benefits Update
- Webinar on Writing Functional Therapy Goals
- Wound Care Equipment and Supply Benefits Change
- Zika Care Connect FAQ
- Zika Care Connect Overview
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To Providers: Please update your enrollment and demographic information with TMHP (Texas Medicaid Healthcare Partnership). TMHP is HHSC’s provider enrollment administrator and serves as the authoritative source for HHSC Providers’ enrollment and demographic information. Once you update your enrollment and demographic information with TMHP, your data will be reconciled with the demographic information on file with the MCOs. To make updates to your current enrollment (e.g., new practice locations or change of ownership updates), please access the web page titled “Provider Enrollment on the Portal – A Step-by-Step Guide” at the following URL:
https://www.tmhp.com/sites/default/files/microsites/enrollment/index.html
For instructions on how to make other demographic updates to your current enrollment, please access the document titled “Provider Information Management System (PIMS) User Guide” at the following URL:
https://www.tmhp.com/sites/default/files/file-library/edi/PIMS-user-guide-r2020-11- 19.pdf
Otherwise, you can contact TMHP directly at 800-925-9126 for assistance.