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4.2 Authorizations
Providers must submit authorization requests on a CSHCN Services Program-approved form when available. If a form is not available for a specific service, providers must submit the request using the "CSHCN Services Program Authorization and Prior Authorization Request Form" and follow the guidelines and requirements listed in the chapter for that service. Only complete authorization requests will be considered. Incomplete requests are denied.
Authorization requests must be submitted within 95 days of the date of service, and may be submitted before the service is provided. If the service has already been provided, the authorization form may be attached to the claim. Claims for services requiring authorization submitted without an attached authorization form and all required documentation are denied.
The 95-day deadline applies to all services requiring authorization, including extensions and emergency situations. Fax transmittal confirmations and postal registered mail receipts are not accepted as proof of timely authorization submission. Authorization requests are reconsidered only when resubmitted and received within the initial 95-day authorization deadline.
Important: No extensions beyond the 95-day initial deadline are given.
Providers must mail or fax written authorization requests, along with all other applicable documentation, to the following address:
Texas Medicaid & Healthcare Partnership
TMHP-CSHCN Services Program Authorization Department
12357-B Riata Trace Parkway, Suite 150
Austin, TX 78727
Fax: 1-512-514-4222
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