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4.2 Definition of Authorization
An authorization is a request submitted to the CSHCN Services Program, or its designated payment contractor, to provide a service the program ultimately considers for reimbursement. The request must be submitted on a CSHCN Services Program-approved form and must contain all information necessary for the program to make a determination about benefits. The request may be submitted before the service is provided, but must not be received by the program more than 95 days following the date the service is provided. If the service has already been provided, the authorization form may be attached to the claim, as long as they are received for processing within the authorization (95-day) deadline. Only complete authorization requests will be considered by the TMHP-CSHCN Services Program. This 95-day deadline applies to all services requiring authorization (not prior authorization), including extensions and emergency situations.
Important: No extensions beyond the 95-day initial deadline are given for providers to correct incomplete authorization requests.
Incomplete authorization requests or claims for services requiring authorization submitted without an attached authorization form and all required documentation are denied and are reconsidered only when resubmitted and received by the TMHP-CSHCN Services Program Authorization Department within the initial 95-day authorization deadline. Requests to extend the deadline beyond 95 days from the date of service are not considered.
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, MC-A11
12357-B Riata Trace Parkway, Suite 150
Austin, TX 78727
Fax: 1-512-514-4222
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