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  • Claim Appeal/resubmission Form - Texas Children's Health Plan - Texaschildrenshealthplan

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Date: Claim Appeal/Resubmission Form This form should be used to resubmit a denied or rejected claim for reconsideration. Section I Claim Detail Member name: Member ID number: Date of service: Claim.

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Claims Filing Information Filing deadlines for all products is 95 days from date of service.

Just call Texas Children's Health Plan's 24-hour Nurse Help Line toll-free at 1-800-686-3831.

Texas Children's Hospital Family Advocacy Department. Patients may call (832) 824-1919 or email famadvocacy@texaschildrens.org. Making a complaint or grievance will not jeopardize patients' current, future, or access to care.

Should you have any questions or concerns please contact your Provider Relations Liaison or the Provider Relations Department at 832-828-1004 or 800-731-8527.

Children in Texas might be able to get low-cost or free health coverage through Children's Medicaid or the Children's Health Insurance Program. Children's Medicaid is a health care program for children in low-income families.

Payer NamePayer IDERAsTEXAS CHILDRENS HEALTH PLAN76048YesTEXAS CHILDRENS HEALTH PLAN-STAR MEDICAID75228YesTEXAS CHOICE75261YesTEXAS FIRST HEALTH PLAN - NTX13185Yes26 more rows

All appeals of claims and requests for adjustments must be received by Texas Children's Health Plan within 120 days from the date of the last denial of and/or adjustment to the original claim.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232