Children's Medical Center Health Plan

Member Services Hotline 

Phone Number: 1-800-947-4969

24 hours a day/ 7 days a week

In case of emergency, call 911 or go to the closest emergency room.

General questions, including but not limited to: eligibility, enrollment, PCP changes, outreach events, migrant farm workers. A representative will be able to assist you with information on accessing covered services.

Interpreter Services are available for all languages, including but not limited to English and Spanish.

TTY: 1-800-735-2989 for hearing impaired clients.

Service Coordination: A service coordinator is available to assist you.  You can reach a Service Coordinator by calling 1-800-947-4969.

 

Provider Services Hotline 

Phone Number: 1-800-947-4969

8 a.m. – 5 p.m. Central Time (CT) Monday through Friday. 

General questions, including but not limited to: eligibility, claims, benefits, authorization information, training events, provider contracts, address changes, general concerns, etc.

 

Behavioral Health Hotline (Beacon Health Strategies)

Phone Number:  1-844-231-7950

Fax Number:  214-867-5516

24 hours a day/ 7 days a week for behavioral health emergencies.

Please call 1-844-231-7950 to speak with a Behavioral Health representative. A representative will be able to assist you with information on accessing covered services. 

Interpreter Services are available for all languages, including but not limited to English and Spanish.

For Substance Abuse Services, you may self-refer to any contracted provider.  If you have any questions, please call 1-844-231-7950 to speak with a Behavioral Health representative. 

Service Coordination: A service coordinator is available to assist you.  You can reach a Service Coordinator by calling 1-800-947-4969

http://beaconhealthstrategies.com/

 

Nurse Advice Line

Phone Number:  1-800-947-4969

24 hours a day/ 7 days a week for questions about member health benefits.

In case of emergency, call 911 or go to the closest emergency room.

If your doctor's office is closed, call the 24-hour Nurse Advice Line for questions about health concerns or health-related topics. 

Interpreter Services are available for all languages, including but not limited to English and Spanish.

TTY: 1-800-735-2989 for hearing impaired clients. 

Providers can access the 24-hour Nurse Advice Line to seek specialty consultations and referrals.

 

Health Management Services (including  Utilization Management, Disease Management and Service Coordination)

Phone Number:  1-800-947-4969

Fax Number:  214-867-5510

8 a.m. – 5 p.m. Central Time (CT) Monday through Friday.  

On each day that is a legal holiday and after-hours, calls will be received by an answering service who will transfer the call to the Health Management Services staff on call, Medical Director or designee.  The Health Management Services staff, Medical Director or designee are also available between 9 a.m. and noon CT, on Saturday, Sunday, and legal holidays.

 

Provider Relations

Phone Number:  1-800-947-4969

Fax Number:  214-867-5395

8 a.m. – 5 p.m. Central Time (CT) Monday through Friday. 

Provider contracts, address changes, general concerns.

 

Claims Administration

Phone Number:  1-800-947-4969

8 a.m. – 5 p.m. Central Time (CT) Monday through Friday. 

Claims status, reconsiderations, appeals and reports.

 

Vision Services (Superior Vision) 

Phone Number:  1-800-879-6901(Members)   1-866-819-4298 (Providers)

Eye exams, glasses, contacts.

https://www.superiorvision.com/

 

​Pharmacy

Children's Medical Center Health Plan Member/Provider Service Hotline

Phone Number:  1-800-947-4969

Call for general questions regarding prescriptions. 

 

Navitus Pharmacy Helpdesk

Phone Number:  1-877-908-6023

Fax Number:  1-855-668-8553

Providers call for claims processing questions.

https://www.navitus.com/ 

 

Navitus Prior Authorization Request Line

Phone Number:  1-877-908-6023

Fax Number:  1-855-668-8553

Providers call for prior authorizations or questions regarding prior authorizations.

 

Other Helpful Numbers

TTY

Phone Number:  1-800-735-2989

For hearing impaired clients.

 

Medicaid Eligibility Verification

Phone Number:  1-800-925-9126 AIS

To verify eligibility with the State.

 

STAR Kids Program Helpline

Phone Number:   1-877-782-6440

Hours of Operation: Monday to Friday from 8a.m. to 5p.m

A member can receive assistance about their coverage as a STAR Kids member.

TTY/TDD: 1-800-735-2989

 

Ombudsman Managed Care Assistance Team

Phone Number:  1-866-566-8989 

To help clients navigate the managed care system, understand Medicaid coverage, rights, and resolve problems. The Office of the Ombudsman is designed to help people already on Medicaid but need help getting health care services.

 

Fair Hearing

To ask for a Fair Hearing, member or the member’s representative should either call the health plan at 1-800-947-4969 or send a letter to:

Children’s Medical Center Health Plan

Attention: Complaints and Appeals

P.O. Box 167688

Irving, TX 75016

1-800-947-4969

 

A member can also send a letter to:  

Texas Health and Human Services Commission

Office of the Ombudsman, MC H-700

P O Box 13247

Austin, TX  78711-3247

 

Medical Transportation Program 

Phone Number:   1-877-633-8747

To arrange for non-emergency transportation to doctor’s office.

 

Click here to print the Contact Us information. 

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