Plan directories and rules
Plan directories and rules
When assisting patients with selecting a Primary Care Provider (PCP), confirm that the provider participates with Dell Children’s Health Plan STAR/CHIP. Patients can use the Find a Doctor tool or click here for the CHIP Provider Directory or STAR Provider Directory. If a patient needs a printed provider directory, we offer a printed directory at no extra cost. You can advise them to contact Dell Children’s Health Plan Member Services at 1-855-921-6284 to request a printed version.
If you are a participating PCP, your office should have processes in place to ensure patients can reach a provider or receive clinical guidance 24 hours a day, 7 days a week. When the office is closed, calls should be directed to an answering service or other appropriate after-hours coverage that can contact the provider to arrange a callback to the member.
Dell Children’s Health Plan also offers a 24-hour Nurse Advice Line at 1-855-712-6700 (TTY 7-1-1) for members who need health advice. Dell Children’s Nurse Advice Line can not be used to meet after hours requirements for your practice.
Members may request to change their PCP at any time by contacting Dell Children’s Health Plan Member Services at 1-855-921-6284 (TTY 7-1-1). Member Services will process the request and inform the member when they may begin receiving care from their newly assigned PCP.
A member’s request to change their PCP may not be approved if:
- The requested PCP does not participate in the Dell Children’s Health Plan network.
- Or the requested PCP is not accepting new patients.
Referrals to specialists
As a primary care provider, you may need to refer a member to see a specialist or another provider for care or services you can’t provide. This is called a referral.
Referrals from a member’s Primary Care Provider (PCP) are not required for Dell Children’s Health Plan CHIP and STAR members to receive specialist services.
Services that members can schedule without a referral from their PCP include OB-GYN, family planning and behavioral health services. This is called self-referral. To get these services, members can make an appointment with a provider in our network. Members can find a list of providers using the Find a Doctor tool. Members can also find behavioral health providers using this tool.
Some services may need to be approved by Dell Children’s Health Plan. If you would like to submit a prior authorization, please visit our Prior Authorization page for more information.
Do you need to update your provider information with Dell Children’s Health Plan?
- If you are an already contracted group but need to add a new provider, you can easily fill out the new Ascension Credentials Verification Services ARF Form. If you have any questions about this new process, please refer to the Ascension Credentials Verification Services (ACVS) FAQ document.
- If you need to make any changes to a provider’s address, phone number, group affiliation or other updates, please fill out our Adds, Changes, and Terms Spreadsheet and email it to our Provider Relations inbox at shpproviderservices@seton.org.
Please ensure your enrollment and demographic information with TMHP (Texas Medicaid & Healthcare Partnership) aligns with the information you submit to Dell Children’s Health Plan. Beginning December 1, 2026, any provider information that cannot be matched in PEMS may receive claim rejections until the information in our systems match what is in PEMS.
