Contracted providers are an essential part of delivering quality care to our members. We value our partnership and appreciate the family-like relationship that you pass on to our members.
In an ongoing effort to improve our web-based services we have created a new Provider Portal. Included in this new secure site you will find:
To become a participating provider
If you are interested in becoming a participating provider for Cook Children's Health Plan, please submit a completed Letter of Interest Questionnaire to Network Development by fax at 682-885-8403 or by email firstname.lastname@example.org. This information will help us in assessing your qualifications with the service needs of our network. Cook Children's Health Plan will respond to your request within 90 days.
Current Children's Health Insurance Program (CHIP) Providers Must Complete Enrollment with TMHP by December 31, 2017 to Continue to Receive Reimbursement for CHIP Services
Federal law and regulation require states to screen and enroll all network providers including Children’s Health Insurance Program (CHIP) providers by December 31, 2017. To meet this requirement and continue receiving reimbursement for services, providers who currently render services to CHIP members through a managed care organization (MCO) must complete enrollment with the Texas Medicaid & Healthcare Partnership (TMHP) by December 31, 2017.
While the enrollment process and application are the same for Medicaid and CHIP providers, CHIP-only providers are not required to participate in Texas Medicaid. CHIP-only providers must follow the instructions below to indicate they intend to serve only CHIP members and to ensure that they do not appear on the Medicaid online provider lookup (OPL).
Note: CHIP providers actively enrolled with TMHP as a Medicaid provider do not need to repeat the enrollment process to continue to receive reimbursement for CHIP services.
Enrollment Information Specific to CHIP Providers
Beginning July 1, 2017, providers can indicate in the enrollment application that they intend to serve only CHIP members. Providers must document this appropriately to ensure they are not displayed as a Medicaid provider on OPL.
CHIP providers are encouraged to enroll using the Provider Enrollment on the Portal (PEP). Additionally, the Provider Information Management System (PIMS) will be updated with options for providers to designate that they intend to serve only CHIP members.
Providers should begin the enrollment process as soon as possible. The PIMS update will allow providers who start the enrollment process before these updates occur, to designate themselves as CHIP-only providers on the OPL after they are enrolled.
For more information, providers should visit the upcoming CHIP webpage that will be added to TMHP.com in the next few weeks.
For more information, call the TMHP Contact Center at 1-800-925-9126.
Additional Payer Available for Electronic Remittance Advice (835)
Availity is pleased to announce that Cook Children's Health Plan now delivers electronic remittance advice (ERA) files via the Availity Health Information Network.
To enroll for ERA delivery on the Availity Web Portal, click Enrollments | ERA Enrollment in the Availity menu, or click ERA Enrollment in the Additional Enrollments section on the Administrator Dashboard. For information about using the ERA enrollment service, review the Enrolling Online for Electronic Remittance Advice topic. You may also call Availity Client Services at (800) 282-4548.
You can also find information about enrolling for ERA delivery with participating payers in the Availity Health Plan Partners list.
To view your ERA files, click EDI File Management | Send and Receive EDI Files in the Availity menu.
If you have any questions please call 1-800-964-2247 Monday through Friday from 8 a.m. to 5 p.m.