To schedule an appointment or need assistance with finding a provider, please call 1-877-DCHP-KIDS.
If you don’t find your PCP listed or need help choosing one, call us at 1-877-220-6376. Your PCP is your home for health care. Your PCP can arrange specialty care as needed. For a complete listing of providers, please visit DriscollHealthPlan.com.
STAR Kids Dual-eligible members are not required to have a PCP.
Your primary care physician may want you or your child to visit a doctor who focuses on certain health-care needs. The Specialty Care Physician collaborates with the Primary Care Physician (PCP) to deliver specialty care to Members. This requires more teamwork between PCPs and Specialists. A Member’s referral is usually initiated during an office visit to the Primary Care Provider (PCP). Referrals usually include visits to the Specialty Care Physician through the Member’s enrollment period. Referrals should be issued prior to the visit to the Specialty Care Physician. No pre-authorization is required for referrals to Driscoll Children’s Hospital campus based Pediatric Specialty Care Physicians.
DHP Members have the right to make a self-referral for certain services. The doctor will talk to you about your/your child’s needs and will help make plans for you to see the specialist that can provide the best care for you. This is called a referral. All requests for services will be reviewed. Requests that are determined to be medically necessary and meet clinical criteria will be approved and given an authorization number. Requests that fail to meet clinical criteria will be referred to the Medical Director for review.
You do not need a referral for:
• True emergency services
• Obstetric services, well-women OB/GYN services
• Behavioral health services (Mental health and substance use disorder)
• Vision care, including covered eye glasses
• Dental services (for children)
• Family planning services.
For questions about the Referral Process Contact the following below:
• STAR/CHIP: 1-877-455-1053
• STAR Kids: 1-844-406-5437
A provider, Member, or someone acting on behalf of a member, may file complaint by called Customer Services at 1-877-220-6376 for Nueces SA or 1-855-425-3247 for Hidalgo. A Member advocate is available to help with filing the complaint.
Appeals are processed in two separate and distinct Departments dependent upon the categorization of appeals.
Provider and Administrative Claims Appeals are processed by the Claims Oversight Department or assistance with these types of appeals; please contact Providers Services at 1-877-324-3627 for Nueces SA and 1-855-425-3247 for Hidalgo SA.
Adverse Medical Determination Appeals are processed by the Clinical Appeals Department. For assistance with these types of appeals, please contact the Clinical Appeals Department at 1-877-220-6376 for Nueces SA and 1-855-425-3247 for Hidalgo SA.