Authorization is not a guarantee of payment. Claims payment is subject to Member Eligibility at the time of service and a properly completed claim form in accordance with applicable National Correct Coding Initiative (NCCI) edits, TMPPM requirements, and DHP claims completion requirements posted on our web site.
Submitting a Request for Authorization: Texas Standard Prior Authorization Request Form.
Requests for Prior Authorization may be submitted through the DHP portal through our web site at www.driscollhealthplan.com (orange link above) or can be submitted by FAX to 1-866-741-5650 using the Texas Authorization Referral Form (TARF). Providers and members can search prior authorization criteria and requirements by selecting the yellow button above.
Member Eligibility: DHP encourages providers to verify eligibility of Medicaid members prior to each service. Eligibility verification is available on the DHP website or on the TMHP website.
Verifying Benefits: It is the Provider’s responsibility to verify the service(s)/procedure code(s) requested is a benefit of Texas Medicaid by utilizing the Texas Medicaid Provider Procedures Manual (TMPPM) and the Texas Medicaid Fee Schedule.
If the service requested is beyond the benefit limit or is not a covered benefit and the provider would still like to submit the request for consideration of medical necessity as a case-by-case benefit exception, the provider should fax the request to the DHP Utilization Management department at the number listed below with a statement on the fax coversheet indicating the requested service is a non-covered benefit or over the benefit limit.
Case by Case Benefit Exceptions: Requests for Case by Case services beyond the benefit limit or which are not a covered benefit may be considered with submission of supporting clinical documentation.
COB: Some outpatient services/procedure codes may require prior authorization regardless of DHP as secondary payer. Providers should verify authorization requirements utilizing the code look up tool found on this website. In cases where DHP is secondary payer and no prior authorization is required, providers should verify the services are a covered benefit by the primary payer.
To obtain assistance submitting a prior authorization request or to receive clarification on our prior authorization requirements, please contact us:
For Member assistance,
please call:
DHP Member Services
Ph: 1-877-324-7543 toll-free
For Provider assistance,
please call:
DHP Utilization Management
Ph: 1-877-455-1053 toll-free
Fax: 1-866-741-5650
DHP STAR Kids LTSS Services
Ph: 1-844-376-5437 toll-free
Fax: 1-844-381-5437
Hours of Operation:
Monday - Friday 8 a.m. - 5 p.m. (CST) (Except state holidays)
Messages will be returned within one business day.