State Of Texas Access Reform Managed Care Program
Community provides both Childrens Medicaid and Medicaid for Pregnant Women. These programs are at no cost to U.S. residents who cannot afford health insurance.
Childrens Medicaid Childrens Medicaid covers a child up through the month of his or her 21st birthday. Income determines eligibility. That income level is different based on age and Medicaid program. Members must recertify every year.
Medicaid for Pregnant Women Medicaid for Pregnant Women covers a childbearing woman of any age. Members must be at 185% or lower of the Federal Poverty Level . Members must recertify every year.
How Can I Make A Same
On average, patients who use Zocdoc can search for a Primary Care Doctor in Houston who takes Texas Children’s Health Plan insurance, book an appointment, and see the Primary Care Doctor within 24 hours. Same-day appointments are often available, you can search for real-time availability of Doctors in Houston who accept Texas Children’s Health Plan insurance and make an appointment online.
What Are The Benefits Of Child Or Youth Mental Health Services
National statistics show that one out of four children will have a mental illness during childhood. Children diagnosed and treated are more likely to succeed at home and in the community.
These services are based upon the childs strengths, needs and preferences. The benefits include:
- Reduction of mental health symptoms
- Development of new communication skills
- Development of new ways to manage emotions
- Development of new ways to relax and create
- Improved social functioning at home and the community
- Services that fit into the childs and familys schedule
- Services provided where the child and family live
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Unitedhealthcare Senior Care Options Plan
UnitedHealthcare SCO is a Coordinated Care plan with a Medicare contract and a contract with the Commonwealth of Massachusetts Medicaid program. Enrollment in the plan depends on the plans contract renewal with Medicare. This plan is a voluntary program that is available to anyone 65 and older who qualifies for MassHealth Standard and Original Medicare. If you have MassHealth Standard, but you do not qualify for Original Medicare, you may still be eligible to enroll in our MassHealth Senior Care Option plan and receive all of your MassHealth benefits through our SCO program.
Welcome Texas Medicaid Providers
WARNING: THIS IS A TEXAS HEALTH AND HUMAN SERVICES INFORMATION RESOURCES SYSTEM THAT CONTAINS STATE AND/OR U.S. GOVERNMENT INFORMATION. BY USING THIS SYSTEM YOU ACKNOWLEDGE AND AGREE THAT YOU HAVE NO RIGHT OF PRIVACY IN CONNECTION WITH YOUR USE OF THE SYSTEM OR YOUR ACCESS TO THE INFORMATION CONTAINED WITHIN IT. BY ACCESSING AND USING THIS SYSTEM YOU ARE CONSENTING TO THE MONITORING OF YOUR USE OF THE SYSTEM, AND TO SECURITY ASSESSMENT AND AUDITING ACTIVITIES THAT MAY BE USED FOR LAW ENFORCEMENT OR OTHER LEGALLY PERMISSIBLE PURPOSES. ANY UNAUTHORIZED USE OR ACCESS, OR ANY UNAUTHORIZED ATTEMPTS TO USE OR ACCESS, THIS SYSTEM MAY SUBJECT YOU TO DISCIPLINARY ACTION, SANCTIONS, CIVIL PENALTIES, OR CRIMINAL PROSECUTION TO THE EXTENT PERMITTED UNDER APPLICABLE LAW.———————–AMA/ADA End User License AgreementLICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION
CPT only copyright 2021 American Medical Association. ALL rights reserved. CPT is a registered trademark of American Medical Association.
You, your employees and agents are authorized to use CPT only as contained in materials on the Texas Medicaid & Healthcare Partnership website solely for your own personal use in directly participating in healthcare programs administered by THHS. You acknowledge that AMA holds all copyright, trademark and other rights in CPT.
U.S. Government Rights
Disclaimer of Warranties and Liabilities
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Do You Need A Translator Or Interpreter
If you do not speak English, a translator can help at no cost during doctor visits. Please let us know if you need a translator at least two days before your appointment by calling 1-855-921-6284 .
For members who do not speak English, we can help in many different languages and dialects, including Spanish.
We can also provide a member handbook in:
- A language other than English or Spanish
Dell Childrens Health Plan will arrange for counseling and education about planning a pregnancy or preventing pregnancy. You can call your primary care provider for help or go to any Medicaid family planning provider. A doctor cant require parental consent for minors to receive family planning services and must keep family planning use confidential.
Dell Childrens Health Plan is a Catholic health plan and follows the rules and teachings of the Catholic Church. Your doctor will bill Medicaid for family planning services.
Some services may require approval. This is called a prior authorization. If you have questions about prior authorizations, please call Member Services at 1-855-921-6284 , Monday through Friday from 8 a.m. to 6 p.m Central time.
Are Video Visits With A Primary Care Doctor Online Covered By Texas Children’s Health Plan
Most insurers provide coverage for video visits at the same cost as in-person visits. You can search on Zocdoc specifically for Doctors in Houston who accept Texas Children’s Health Plan for video visits by selecting your carrier and plan from the drop-down menu at the top of the page. We recommend you check with your insurance carrier directly to confirm your coverage and out of pocket costs for video visits.
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Who Is Eligible For Autism Benefits
Effective February 1, 2022, Autism Services, to include Applied Behavior Analysis evaluation and treatment, became a benefit of the Texas Health Steps-Comprehensive Care Program for Texas Medicaid recipients who are 20 years of age and younger and who meet the criteria outlined in the Autism Services benefit description. This benefit is not available for CHIP recipients.
How Can I Book An Appointment Online With A Texas Children’s Health Plan Primary Care Doctor In Houston
Zocdoc is a free online service that helps patients find Texas Children’s Health Plan Doctors in Houston and book appointments instantly. You can search for Texas Children’s Health Plan Doctors in Houston by symptom or visit reason. Based on that information, youll see a list of providers who meet your search criteria, along with their available appointment slots.
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Unitedhealthcare Dual Complete Plans
Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a contract with the State Medicaid Program. Enrollment in the plan depends on the plans contract renewal with Medicare. This plan is available to anyone who has both Medical Assistance from the State and Medicare. This information is not a complete description of benefits. Call TTY 711, or use your preferred relay service for more information. Limitations, co-payments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.
Medicaid Is Vital To Children And The Providers That Serve Them
Without adequate funding, childrens hospitals cannot continue to provide services that children desperately need, like organ transplants, heart surgery, or treatment for cerebral palsy or spina bifida. Of the 7.5 million children in Texas, more than half 4 million receive their health care through Medicaid or the Childrens Health Insurance Program . Because so many children in Texas are enrolled in Medicaid and CHIP, childrens hospitals are heavily dependent on these programs.
Protecting Medicaid for children helps ensure that they get access to appropriate health care. Early detection and intervention are the best ways to help kids get off to a good start. Children enrolled in Medicaid are more likely to attend school, graduate from high school and go to college, allowing them to become healthier adults who can earn more and pay more in taxes than the children who do not have appropriate health care.
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Provider Resources On Covid
Texas Childrens Health Plans automated Telephone TouCHPoint system allows Texas Childrens Health Plan providers to check eligibility, benefits, and claims status after hours.
The service is available 24 hours a day, 7 days a week. To access Telephone TouCHPoint call832-828-1007. Enter the members identification number and the providers NPI number.
To hear a claim status, you will need your NPI number as well as the Tax ID for which the claim was billed. The requested information will be emailed to the email address on file with Texas Childrens Health Plan.
For additional information about Telephone TouCHPoint, please contact your Provider Relations Manager or call 832-828-1008 or toll-free at 1-800-731-8527.
Unitedhealthcare Connected General Benefit Disclaimer
This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Member Handbook. Limitations, copays and restrictions may apply. For more information, call UnitedHealthcare Connected® Member Services or read the UnitedHealthcare Connected® Member Handbook. Benefits, List of Covered Drugs, pharmacy and provider networks and/or copayments may change from time to time throughout the year and on January 1 of each year.
You can get this document for free in other formats, such as large print, braille, or audio. Call Member Services, 8 a.m. – 8 p.m., local time, Monday – Friday . The call is free.
You can call Member Services and ask us to make a note in our system that you would like materials in Spanish, large print, braille, or audio now and in the future.
Language Line is available for all in-network providers.
Puede obtener este documento de forma gratuita en otros formatos, como letra de imprenta grande, braille o audio. Llame al Servicios para los miembros, de 08:00 a. m. a 08:00 p. m., hora local, de lunes a viernes correo de voz disponible las 24 horas del día,/los 7 días de la semana). La llamada es gratuita.
Puede llamar a Servicios para Miembros y pedirnos que registremos en nuestro sistema que le gustaría recibir documentos en español, en letra de imprenta grande, braille o audio, ahora y en el futuro.
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Do You Qualify For Texas Star
Thinking about becoming a Community Health Choice Member? Here are some quick facts about the Medicaid Program and Community Health Choice to get you started.
Important: The state of Texas has automatically extended CHIP and STAR Medicaid benefits since the federal government issued a public health emergency due to the COVID-19 epidemic.
Visit our public health emergency site for more information.
How Much Does It Cost
Children’s Medicaid is free.
If we find your child can get Children’s Medicaid, there is no cost to receive services.
CHIP fees vary based on your income.
If we find your child can get CHIP, your enrollment fee and co-pays will be based on your family’s income. Enrollment fees are $50 or less per family, per year.
Co-pays for doctor visits and medicine range from $3 to $5 for lower-income families and $20 to $35 for higher-income families.
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Texas Healthy Women Program
Lost your Medicaid benefits? The Texas Healthy Women Program provides family planning exams, related health assessments, and birth control to women ages 18 to 44 whose family income is at or below the programs income limits . of poverty).
You must apply to find out if you can receive services through this program. Visit this site for more information.
Filing Claims For Managed Care Services
Claims for services administered by a medical or dental plan must be submitted to the plan. Providers may submit managed care claims by the following:
- Submit acute, long term services or dental claims directly to the appropriate medical or dental plan using the methods established by the plan.
- Submit acute care or dental claims electronically to TMHP for routing to the appropriate medical or dental plan.
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Clinical And Administrative Advisory Committee Behavioral Health Advisory Committee Perinatal Advisory Committee
These Provider Advisory Groups provide recommendations to Texas Childrens Health Plan in the following areas:
- Identification and review of clinical practice guidelines and prior authorization guidelines
- Review of general utilization patterns and assessment of Provider compliance with clinical guidelines
- Recommendations for member engagement and quality improvement programs to improve health outcomes and keep members healthy
- Strategies and recommendations for improving Health Plan administrative processes
- Recommendations on how to improve care based on Member feedback and their personal experiences serving our Members and
- Opportunities for connecting network Providers and Managed Care Organization clinical experts for purposes of peer support and sharing best practices.
There is a Clinical and Administrative Advisory Committee for each of our three Service Areas:
The Behavioral Health Advisory Committee and Perinatal Advisory Committee meet in the Harris Service Area.
The meeting cadence for each of the committees are as follows:
- Clinical and Administrative Advisory Committee meets 9 times per year in the Harris Service Area and quarterly in the Jefferson and Rural Service Area Northeast
- Behavioral Health Advisory Committee meets quarterly
- Perinatal Advisory Committee meets quarterly
Are Video Visits With A Dermatologist Online Covered By Texas Children’s Health Plan
Most insurers provide coverage for video visits at the same cost as in-person visits. You can search on Zocdoc specifically for Dermatologists in Houston who accept Texas Children’s Health Plan for video visits by selecting your carrier and plan from the drop-down menu at the top of the page. We recommend you check with your insurance carrier directly to confirm your coverage and out of pocket costs for video visits.
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Childrens Hospitals Are Often The Only Place To Get Life
Childrens hospitals are the pediatric safety net for all Texas children and have unique services and expertise in the care of children. Childrens hospitals serve our states most ill children by providing specialized care that they cannot receive elsewhere.
Texas has one of the fastest-growing child populations in the country. To meet the needs of our children, it is critical to build the clinical facilities and programs needed to serve our children, from primary care to the most advanced specialty services. Childrens hospitals are recruiting and training doctors, nurses and other pediatric providers to meet the needs of children and are conducting research to improve and advance the efficiency and effectiveness of medical care.
We Put Your Family At The Center Of Care
Our patients are important. We know that you are busy and that raising kids is difficult. So, we created The Center for Children and Women. It is a new kind of medical facility designed to put everything in one place. It offers state-of-the-art health-care services. And, its only for Texas Children’s Health Plan members.
The Center for Children and Women offers you safe and convenient ways to see your doctor. In-person and telehealth appointments are available.
Everything you need in one place.
- CheckupsIf you are looking for a main doctor or need a routine check up, we have what you need.
- Eye tests, screenings, prescriptionsYour vision is very important to our on-site eye doctors.
- Teeth cleaning, cavitiesOur dentists offer a full range of services to keep your mouth healthy.
- Pregnant? Be sure to start early. Visit our OB doctors to ensure the best care for you and your baby.
- Women’s HealthWe offer gynecological health care for women at every stage of life.
- Need lab tests? You will appreciate the convenience of our in-house labs and x-rays.
- Need medicines? There is a pharmacy located in our facility with curbside pickup available.
- Speech TherapyFocused, one-on-one therapy with a highly trained speech language specialist.
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Chip Does Not Cover Long
If you have a child with a disability and make too much money to get Medicaid, you might be able to get coverage through the Medicaid Buy-In for Children program. MBIC allows families of children with disabilities to make a monthly payment to get Medicaid coverage.
Learn about other programs and services for people with disabilities.
I Need Health Care For My Children But I Make Too Much Money To Get Medicaid
Children’s Health Insurance Program is a health care program for children whose families earn too much to get Medicaid but can’t afford insurance.
CHIP offers many of the same services as Medicaid but does not cover long-term services and supports.
To find out if you can get CHIP, apply for Medicaid and we’ll determine if you qualify.
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Drug Rehab & Alcohol Treatment Center
The Texas Childrens Health Plan collaborates with Medicaid and the Childrens Health Insurance Program to cover the costs of drug and alcohol treatment. ADAPT Programs and Brazos Place works with the Texas Childrens Health Plan to ensure that young adults and teens who are registered in Medicaid can receive comprehensive treatment for substance use disorders and mental health problems.
The best way to find what services you are eligible for under our award-winning drug rehab programs is to give our staff a call today. We will work with you to help you understand what programs and services are best for your needs, and what costs Texas Childrens Health Plan could cover for your needs.
Give our dedicated and experienced advisers a call today at .
Without needing prior authority your Texas Childrens Health Plan dependency treatment insurance, ADAPT Programs and Brazos Place may be able to work with your insurance provider to cover the following outpatient drug rehab services: counseling, drug and alcohol detox, dependency and medical evaluations, and drug assisted therapy.
Pre-authorization is needed, and our professional counselors will work with you and your insurance provider to find the best solutions for your needs.
The easiest way to know the details of whats insured would be to call our healing specialists at . We will work with Texas Childrens Health Plan dependency treatment insurance representatives to optimize the coverage that is available for you.
Why Choose Community
As a local nonprofit health plan, Community Health Choice gives you plenty of reasons to join our Community. From the benefits and special programs we offer to the way our Member Services team helps you make the most of them, Community is always working life forward for you and your family.
I always tell people to choose Community Health Choice. I tell them its the best health insurance they will ever be with. Chandolyn
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