Mental Health and Substance Use Services for Adult Members

Provider Resources

Welcome to our provider resources hub. Here, healthcare professionals will find a range of tools and information to help streamline excellent patient care.

Prior Authorization Portal

Our prior authorization portal is a user-friendly platform designed to simplify the prior authorization process and limit unnecessary delays in patient care. Learn when prior authorization is necessary, submit requests electronically check about the status of your requests. The search function includes a wide range of categories that allow professionals to look up authorization requirements for any CPT/HCPCS code.

Provider Portal

Please log in to your portal using the below link. To gain exclusive access for your staff, download and complete the Provider Portal Sign-Up form.

DHP Procedures

Click the topics on the left to show more detail.
Click the topics below to show more detail.
Provider Claims Appeals
Provider Complaints
Contracting and Credentialing
DHP Agreement Forms
Primary Care Physician Form
Provider Enrollment
Medical Protocols and Information
Education Materials-Provider Training Resources
Education Materials-Cultural Competency and Sensitivity
EDI Resources

Provider Claim Appeals

Claim Appeals may be submitted via:

DHP Provider Portal

Email: [email protected]

Fax: 1-361-808-2776

Mail:
Driscoll Health Plan
ATTN: Claims Appeal Department
PO Box 3668
Corpus Christi, TX 78463-3668

Contact Information:
Nueces SA: 1-877-324-3627   
Hidalgo SA: 1-855-425-3247 

Provider Complaints

Contact Information:
Driscoll Health Plan – Quality Management Department
ATTN: Performance Excellence Team
4525 Ayers Street
Corpus Christi, Texas 78415
Phone Number:
Nueces SA: 1-877-220-6376 
Hidalgo SA: 1-855-425-3247 
Fax  Number:
1-361-808-2725
Email:
[email protected]
Provider Portal:
DHP Provider Portal

Once you have gone through the Driscoll Complaint Process, and you are not pleased with the response, you may file your complaint directly to the Health and Human Services Commission (HHSC) by calling toll-free 1-866-566-8989. If you would like to make your complaint in writing, please send it to the following address:

Texas Health and Human Services Commission
Health Plan Operations – H-320
ATTN: Resolution Services
P.O. Box 85200
Austin, TX 78708-5200

Contracting and Credentialing

DHP looks forward to working with you!

To contract and credential with Driscoll Health Plan, please complete the following form and email: [email protected]. Complete this form for all practices or facility locations.

Upon receipt of this request form, DHP will notify Verysis (CVO) to start the credentialing process with your completed credentialing application on CAQH or Availity.

Ensure all information in CAQH or Availity is updated and required documents are current. Please note that providers must be enrolled in Texas Medicaid and have an active NPI before submission of this request.

Provider Enrollment

To Providers: Please update your enrollment and demographic information with TMHP (Texas Medicaid Healthcare Partnership). TMHP is HHSC’s provider enrollment administrator and serves as the authoritative source for HHSC Providers’ enrollment and demographic information. Once you update your enrollment and demographic information with TMHP, your data will be reconciled with the demographic information on file with the MCOs.

To make updates to your current enrollment (e.g., new practice locations or change of ownership updates), please access the web page titled “Provider Enrollment on the Portal A Step-by-Step Guide

For instructions on how to make other demographic updates to your current enrollment, please access the web page titled “Provider Enrollment and Management System (PEMS)” . Otherwise, you can contact TMHP directly at 800-925-9126 for assistance.

Educational Materials

Provider Training Resources

Target Audience: Healthcare professionals who care for children, including community and hospital-based physicians, physician assistants, allied healthcare providers, residents, and medical students

CME Quarterly Meetings Flyer

Target Audience: Non-clinical healthcare professionals who offer administrative support to provider offices including office managers, medical assistants, referral clerks, and front office specialists

Quarterly Meetings
HHS - EVV Training
Texas Health Steps
Cultural Competency and Sensitivity

Cultural Competency and Sensitivity

Driscoll Health Plan (DHP) fosters an environment of care that acknowledges and respects the culture, language, beliefs, and health literacy of Members and their families. DHP recognizes that these factors affect the health and wellbeing of our members, and strives to ensure that its services meet the challenging needs of an increasingly culturally and linguistically diverse populations, advance health equity among its members and achieve quality outcomes.

DHP will ensure the effective delivery of services in a manner that respects Members linguistic needs, diverse cultural, racial and ethnic backgrounds, religion and religious preference(s), disabilities, and gender and preferred gender. DHP will monitor and assess member needs through the direct and indirect data collected on its membership, and ensures that Providers and Staff appreciate the customs, values, beliefs and abilities of its membership in the subsequent delivery of care and services.

DHP is committed to identifying and addressing health disparities among our Members and actively works with community resources to reduce inequalities in healthcare delivery caused by a lack of awareness or understanding of cultural and language differences, gender identity, and social and economic disparities. DHP partners with several community organizations that assist us in delivering health care messages to our members within hidden communities who are often underserved by community services and public infrastructure. DHP participates in and sponsors numerous programs to benefit these communities, such as providing community health screenings.

News and Notifications

Authorization Requirement Updates - Pharmacy, DME, and Home Infusion Services_10.23.2024 Authorization Requirement Updates - COVID-19 Vaccines_10.23.2024 Authorization Requirement Updates - Pharmacy and Allergy Services_10.09.2024 Medical Necessity Guidelines Update - Behavioral Health and Substance Use Disorder Non-Covered Benefit Process_10.03.2024 In Lieu of Services Provider Education_10.01.2024 Authorization Requirement Updates for Behavioral Health Services_In Lieu of Services_10.01.2024 Authorization Requirement Update - Therapy Re-evaluations_10.01.2024 Authorization Requirement Updates_Wound Care Services_10.01.2024 Authorization-Requirement-Updates-Pharmacy-Services 09.16.2024Attention Provider Portal Update - New Referral Type 09.05.2024Auth Req Updates - Neurotransmitter_Prev Med_and Dental Anes Services_2nd Notice 08.30.2024  Authorization Requirement Updates - General Surgery_Orthopedic_and Pharmacy Services 08.27.2024Authorization Requirement Updates - Genetics_Lab_Pharm_Neurotransmitter_Preventative Med_and Dental Anes 08.22.2024 Authorization Requirement Updates - GI and Resp. PCR Testing 08.06.2024Authorization Requirement- Rural or Federal Heath Center, Pharmacy Services 07.18.2024 DHP Provider Portal and HEDIS 07.02.24Authorization Requirement Updates-06.28.24Co-pays for CHIP COVID-19 services-06.28.24TMPPM Update of Elevated Blood Lead Level-06.28.24Hepatitis C Information Letter-6.14.24Authorization Requirements-Pharmacy Services-4.11.24Post-Partum Eligibility and Billing TMHP for Claims-3.28.24Authorization Requirement Updates - Cardiology Services-3.27.24EDI Claims Transactions Now Available through Availity-3.22.24EDI Claims Transactions Now Available through Availity-3.13.24EDI Claims Transactions Now Available through Availity-3.8.24Change Healthcare/Optum Update-3.6.24Change Healthcare/Optum Update-3.1.24Change Healthcare/Optum Update-2.27.24Change Healthcare/Optum Update-2.23.24Change Healthcare/Optum Update-2.22.24Download - Provider Newsletters: April 2023 PDFDownload - Provider Newsletters: August 2023 PDFDownload - Provider Newsletters: October 2023 PDFDownload - Provider Newsletters: December 2023 PDFDownload - Provider Newsletters: April 2024 PDFDownload - Provider Newsletters: June 2024 PDFDownload - Provider Newsletters: August 2024 PDF

Provider Advisory Committee

At Driscoll Health Plan, we value your opinion. For meeting times, dates, and locations, please contact Provider Relations at 956-632-8308 or [email protected].

Provider Advisory Committee List
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