Authorizations
- Standard Prior Authorization Form
- Prior Authorization Requirements
- Prior Authorization Reference Information
- Prior Authorization Update Summary
- Clinical and Administrative Advisory Committee - Annual Review Summary
- Authorization Process Required Information
Prior Authorization Fax Lines
- Medical Services Fax Line - 832-825-8760 or Toll-Free 1-844-473-6860
- Behavioral Health Services Fax Line - 832-825-8767 or Toll-Free 1-844-291-7505
- LTSS and Private duty Nursing Fax Line - 346-232-4757 or Toll-Free 1-844-248-1567
Contact Us
Please contact us if you have questions or need assistance with prior authorizations.
Providers: 1-800-731-8527
Providers may also reach out to their Provider Relations Liaison, contact information is available here.
Members:
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CHIP 1-866-959-6555
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STAR 1-866-959-2555
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STAR Kids 1-800-659-5764
Texas Children’s Health Plan offers TDD.TTY services for deaf, hard of hearing or speech impaired members and providers. For TDD assistance, please call 1-800-735-2989 or 7-1-1.
Prior Authorization Determinations
The Utilization Management department processes service requests in accordance with the clinical immediacy of the requested services.
| Authorization | | Turnaround Time |
| Routine | Within 3 business days after receipt of request |
| Urgent | Within 1 business day after receipt of request |
| Inpatient | Within 1 business day after receipt of request |
Prior Authorization Guidelines
Below you will find all of the Prior Authorization Guidelines. If you wish to open the following forms, you must have Adobe Acrobat Reader installed on your computer. To download a form, right click on one of the links below and select "Save Target As."
Providers should reference the guidelines listed below for a specific service. Each guideline lists the required documentation and forms that must accompany an authorization request.
Download a free copy of Adobe Acrobat Reader, click here.
- Augmentative Communication Device Guideline
- Bariatric Surgery Guidelines
- Behavioral Health Level of Care TCHP Guideline
- Botulinum Toxin Guidelines
- Circumcision Guidelines
- Clinician Administered Drug Guideline
- Cosmetic Surgery Guidelines
- Cranial Molding Orthosis Guidelines
- Day Activity and Health Services (DAHS) Guideline
- Developmental Screening Guidelines
- Durable Medical Equipment (DME) Repair Guideline
- Gait Trainers and Standers Guidelines
- General Anesthesia for Dental Procedures in Members 6 years old and Younger
- Genetic Testing Guidelines
- Home Health Guidelines
- Hospital Bed Guidelines
- Hospital Grade Blood Pressure Device Guidelines
- Hospital Inpatient Care Guidelines
- Implantable Hearing Device Guideline
- Magnetoencephalography Guidelines
- Miscellaneous DME (E1399) when billed amount exceeds $500
- NIPT - Genetic Testing Guidelines
- Non-Emergency Ambulance Guidelines
- Nutritional Supplements Guideline
- Occupational Therapy Guidelines
- Oral Surgery Guidelines
- Organ Tissue Transplant Guidelines
- Orthoses Guideline
- Out of Network Services Guideline
- Outpatient Psychotherapy Visits Greater than 30 per Calendar Year
- PAP Device Guidelines
- PDN Guidelines
- PET Scan Guidelines
- Physical Therapy Guidelines
- Private-Duty Nursing Guidelines
- Progesterone Therapy Guidelines
- Prosthetics Guidelines
- Psychological/Neuropsychological Testing Guidelines
- Secretion and Mucous Clearance Devices Guideline
- Skilled Nursing Facility Guidelines
- Skills Training Request for CHIP Members Guideline
- Sleep Studies in Children Guidelines
- SPECT Scan Guidelines
- Speech Therapy Guidelines
- Targeted Case Management & Mental Health Rehabilitation Guideline
- Telemonitoring Guideline
- Temporomandibular Joint (TMJ) Guidelines
- Therapeutic and Reconstructive Breast Procedures Guideline
- Therapeutic Continuous Glucose Monitors (CGMs)
- Wheelchairs Guidelines