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:
Cook Children's Health Plan (CCHP) has been awarded a new program, titled "STAR KIDS" by the Health and Human Services Commission (HHSC). CCHP will be administering this program in the Tarrant service area.
To participate in the STAR Kids program please complete the Letter of Intent (LOI) and Provider Data Information (PDI) forms located in the Forms section of this website. Your signature on this LOI will allow us to include you as a participating provider within our network. The form can be faxed to Network Development at 682-885-8403 or emailed to firstname.lastname@example.org.
If you have any questions please call 682-885-2247, a Network Development representative is available to assist you Monday-Friday from 8:00a.m. to 5:00p.m.. Thank you for considering participation with CCHP in the STAR Kids program.
Texas Medicaid & Healthcare Partnership Re-enrollment
The Centers for Medicare and Medicaid Services (CMS) recently announced that the previous March 24, 2016 deadline for Medicaid provider re-enrollment is extended to Sept. 25, 2016. Though this extension gives states additional time to ensure providers comply with Patient Protection and Affordable Care Act (PPACA) requirements, Texas Medicaid encourages all providers who have not yet submitted a re-enrollment application to begin this process immediately.
To avoid potential disruption in payment, a complete re-enrollment application must be received on or before June 17, 2016 in order to be revalidated by Sept. 24, 2016. Complete applications that are received on or before June 17, 2016, will most likely complete the re-enrollment process by Sept. 24, 2016.
For additional guidance on re-enrollment, please visit TMHP Provider Re-Enrollment web page.
For assistance with the re-enrollment process contact a TMHP provider enrollment representative at 1-800-925-9126, Option 2 or email email@example.com.
Cook Children's Health Plan covers emergency and medically necessary non-emergency ambulance transportation.
Emergency Ambulance Transportation - In the event a Member's condition is life-threatening or potentially life-threatening and requires the use of special equipment, life support systems and close monitoring by trained attendants while en route to the nearest medical facility, the ambulance transport is considered an emergency service and does not require Cook Children's Health Plan prior authorization.
Facility to facility transportation is considered emergent when meeting the definition found in 1 TAC §353.2. Facility to facility transport is considered emergent when the service is not eligible at the first facility.
Non-Emergency Ambulance Transportation -
Non-emergency ambulance transportation is defined as ambulance transport provided for a Cook Children's Health Plan Member to or from a scheduled medical appointment, to or from a licensed facility for treatment, or to the Member's home after discharge when the Member has a medical condition such that the use of ambulance is the only appropriate means of transportation. Non-emergency ambulance transportation services must be prior authorized and coordinated by Cook Children's Health Plan before an ambulance is used to transport a Member in circumstances not involving an emergency.
Prior authorization requests for non-emergency ambulance transportation must be submitted by the Member's provider of record. The provider of record is defined as the physician, doctor, or other health care provider that has primary responsibility for the health care services rendered or requested on behalf of the Member or the physician, doctor or other health care provider that has rendered or has been requested to provide the health care services to the Member.
Ambulance providers cannot request prior authorization for these services; however may coordinate the exchange of information such as their National Provider Identification (NPI) number and other business information to facilitate communication.
The provider of record or those acting on their behalf may request approval for an ambulance by using the Texas Standard Prior Authorization Request Form for Health Care Services found in the Appendix section of this provider manual and on our website cookchp.org. Cook Children's Health Plan will provide the approval or denial for the prior authorization to the requesting provider and the ambulance provider.
Does your patient need a dentist? Then we have exciting news!
Cook Children's has a new clinic located at 2600 East Berry Street, Fort Worth, TX.
This new clinic provides dental services for children 6 months to 18 years old. Accepting CHIP & Medicaid (STAR).
The dental staff can provide exams, digital x-rays, cleanings, fluoride treatments, fillings, crowns, root canals, and provide patient education.
Please refer your patient to our dental clinic today or have them call and schedule an appointment at: (817) 347-4600.
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.
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.