Effective October 1, 2018, the Children with Special Health Care Needs (CSHCN) Services Program Prior Authorization Request for Inpatient Hospital Admission-For Use by Facilities Only Instructions will be updated to clarify diagnosis, date requirements, and resubmission guidelines for emergency hospital admission requests.
If an initial request for an emergency hospital admission is received timely, and the request is denied for incomplete or inaccurate information, providers may correct and resubmit the prior authorization request. The corrected request is a one-time resubmission only, and it must be received by the next business day following the denial of the initial request. Corrected requests received after the next business day following the initial denial will be denied for the entire hospital stay.
If the corrected request is received by the next business day and still includes incomplete or inaccurate information, the request will be denied for the entire hospital stay and providers will not be able to resubmit a second time.
For more information, call the TMHP-CSHCN Services Program Contact Center at 800-568-2413.