Providers

Resources & Information

To verify member eligibility, benefits, prior authorizations, claim questions or Provider Relations, contact:

  • Provider Services for Hidalgo Service Area (1-855-425-3247)

  • Provider Services for Nueces Service Area (1-877-324-3627)

  • Preauthorization and Referrals (CHIP/STAR/STAR Kids) – Utilization Management Department (1-877-455-1053; FAX: 1-866-741-5650)

  • Prior authorization for PDN, PCS, and LTSS services (1-844-376-5437 /Fax: 1-844-381-5437)


Prior Authorization

Our tool contains information about our Prior Authorization process and when you will need to obtain one.

To access this information, we provided a wide range of categories and a searchable tool that allows you to enter any CPT/HCPCS code.


PCP Virtual Lecture Series-

Join our Continued Medical Education (CME) virtual series on June 28, 2022 at 6:30p.m. CDT.

Topic: “Realistic Approaches to Children with Developmental Disabilities: Therapy and DME”

DHP PCP Incentives, Provider Advisory Comments, Q&A. Offered both in-person and on WebEx.


Contact Information:

Claim Appeals may be submitted via:

You may also submit your Claim Appeal by mail:

Claims Administration
PO Box 3668
Corpus Christi, TX 78463

Contact Information

Driscoll Health Plan
ATTN: Performance Excellence Team
4525 Ayers Street
Corpus Christi, Texas 78415
Phone Number: 1-877-220-6376 (Nueces SA) or 1-855-425-3247 (Hidalgo SA)
Fax Number: 361-808-2725
Email: DHP_QM_Complaints@dchstx.org

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

If you can get on the internet, you can send your complaint in an email to HPM_Complaints@hhsc.state.tx.us


Driscoll Health Plan places great emphasis on the wellness of its Members. A large part of quality health care delivery is treating the whole patient and not just the medical condition. Sensitivity to differing cultural influences, beliefs and backgrounds can improve a provider’s relationship with patients and in the long run the health and wellness of the patients themselves. DHP encourages all providers to be sensitive to varying cultures in the community.

For more information, please visit the Texas Health Steps website.

 

DHP offering Cultural Competency Training Available for Providers

What is cultural competency and why does it matter to you or healthcare? Providers are providing care to diverse patients and their families. Effective communication between the provider and the member leads to better health outcomes. In addition, provider cultural competency supports unbiased quality care and delivery of care that is respectful of the beliefs, and cultural and linguistic needs of diverse patients while also reducing health disparity and improving access to high-quality care.

DHP is promoting THSteps and other providers to take advantage of the Health and Human Services (HHS) Texas Health Steps Culturally Effective Heath Care CE Online course. HHS is offering 1.00 CE hours for the completion of this course.

https://www.txhealthsteps.com/500-culturally-effective-health-care

This course/module will equip Texas Health Steps providers and others to employ best practices and professional ethics to serve the healthcare needs of culturally diverse children and adolescents and their families, as well as to meet legal requirements for confidentiality, informed consent, and language assistance to families who are not proficient in English.