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Providers FAQs

General

Q: How do I apply to become a Network Provider?
A: If you would like to apply to become a Network Provider, please fill out the Letter of Interest Questionnaire and return to Network Development by fax (682) 885-8403 or email CCHPNetworkDev@cookchildrens.org

Q: How do I reach Provider Relations?
A: Call 800-964-2247 or Email CCHPNetworkDev@cookchildrens.org

Q: What should I do if I want to file a complaint?
A: To file a provider complaint, please use the following contact information:
Contact: 682-885-2866
Fax: 682-885-2148
Email: CCHPCompliance@cookchildrens.org

Q: What should I do if I want to file a complaint to HHSC?
A: To file a provider complaint to HHSC, providers must submit a letter to the following address:

Texas Health and Human Services Commission
Re: Provider Complaint
Health Plan Operations, H-320
PO Box 85200
Austin, TX 78708
State inbox contact : HPM_Complaints@hhsc.state.tx.us

Q: What should I do if I want to file a claim appeal?
A: : To file a claim appeal, please use the following contact information:

Cook Children’s Health Plan
Attention: Appeals
P.O. Box 2488
Fort Worth, TX 76113-2488
Fax: 682-885-8404
cchpclaimappeals@cookchildrens.org

Q: Are Members assigned a Primary Care Provider (PCP)?
A: Yes, Members are required to select a Primary Care Provider (PCP) upon enrollment.

Q: How does a member change their primary care provider ?
A: Members can call our Member Services hotline at 1-800-964-2247 to change their primary care provider.

Q: What is the CCHP service area?
A: Our service area includes Denton, Hood, Johnson, Parker, Tarrant, and Wise.

Q: Do you pay for school/sports physicals?
A: Yes, one school/sports physical is allowed per calendar year for members 18 years of age and younger.

Q: What products are available through Cook Children’s Health Plan?
A: CHIP, CHIP Perinate, STAR, and effective 11/01/2016 STAR Kids

Q: Can I check what services require prior authorization?
A: Yes,  you may log in to cookchp.org, proceed to the Provider screen, and select Prior Authorization Look Up.

Q: What are value added services?
A: Value added services, approved by HHSC, are extra health services offered by the health plans in addition to regular Medicaid services.

Q: How can a member change health plans?
A: A member can change health plans any time by contacting Maximus, the State’s enrollment broker.  It can take 30 to 45 days for the change to go into effect. 


Claims

Q: Can I submit claims electronically?
A: Yes, through Availity using the following payor id’s:

STAR – CCHP 9
CHIP  – CCHP1

Q: Where can I submit paper claims?
A: You can submit your paper claims to the following address:

Cook Children’s Health Plan
P.O. Box 961295
Fort Worth, TX  76161-1295

Q: What if a member has private health insurance?
A: If a member has private health insurance through their employer, the health insurance marketplace, or another entity, the private insurance should be billed first.


Provider Portal

Q: Is there any customer support for the Web portal?
A: Contact Network Development at 800-964-2247 for any issues, concerns or questions.

Q: How do I apply for access to the Web portal?
A: Participating providers may go to cookchp.org, proceed to the Provider screen and select Provider Secure Portal to create an account.  

Q: Can you request online prior authorizations?
A: You may request online authorizations and may check the status of your request through the Provider Secure Portal.

Q: What kind of functions can I perform on the Web portal?
A: Here are some features currently available to participating providers:

  • Verify Patient Eligibility
  • Verify Other Health Insurance Information
  • Submit Claim Appeals
  • Check Claim status
  • Submit and Review Online Authorization
  • Primary Care Providers have access to print and download their membership listing

STAR Kids

Q: What is STAR Kids? 
A: STAR Kids is a new Texas Medicaid managed care program for children and adults 20 or younger who have disabilities. Under STAR Kids, you will get basic medical and long‐term services and supports through the health plan's provider network. Long‐term services and supports include things like help in your home with basic daily activities, and help participating in community activities, if you are eligible. You also will get Medically Dependent Children's Program (MDCP) waiver services through the health plan's provider network, if you are eligible.

Q: What STAR Kids health plans are within the surrounding counties?
A: The following health plans participate in the Dallas and Tarrant area:

Dallas Service Area:
Amerigroup
Children’s Medical Center Health Plan

Tarrant Service Area:
Aetna
Cook Children’s Health Plan

Q: How do I apply to become a provider for STAR Kids?
A: If you would like to apply to become a Network Provider, please fill out the Letter of Interest Questionnaire and return to Network Development by fax (682) 885-8403 or email CCHPNetworkDev@cookchildrens.org.