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CSHCN Provider Manual Update for Emergency Inpatient Hospital Admissions

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On July 1, 2022, TMHP will update the Children with Special Health Care Needs (CSHCN) Services Program Provider Manual to update language for emergency inpatient hospital admissions. 

The following statements will be updated in section 24.3.1.2, “Emergency Inpatient Hospital Admissions”:

"Requests for emergency admissions must be received within 48 hours of an admission or by the next business day for weekend admissions. Late submitted requests for emergency admissions will be denied for the entire hospital stay.

If the initial prior authorization request meets the deadline requirements and is denied for incomplete or inaccurate information, the provider may correct and resubmit the prior authorization request. The corrected request is a one-time resubmission that must be received within five business days following the denial of the initial request. If the corrected request still contains incomplete or inaccurate information, the request will not be eligible for a second resubmission and will be denied for the entire hospital stay. Corrected requests received after the five business days following the initial denial will be denied for the entire hospital stay."

For more information, call the TMHP-CSHCN Services Program Contact Center at 800-568-2413.