Let’s build a healthier community together
We share a common goal: to improve the lives of the people we serve.
We're committed to supporting you with the tools and information you need be our partner in caring for our members.
In this section, you’ll find important details about our clinical programs and guidelines as well as resources to assist you with coding, billing practices, formularies and improving patient care quality.
The provider facings systems are intended to be available 24/7. Maintenance activities are planned to occur in non-working hours and the downtimes are less than a minute. In the unlikely case of system/company-wide outages, communication is sent to all the provider relations admin through centralized Medicaid IT application support team who in turn notify the providers.
This 24-hours-a-day, 7-days-a-week service enables all members to have ready telephonic access to clinical support from experienced Registered Nurses. The nurses will be available through a toll-free telephone number at 1-800-556-1555. We will provide TTY service for the hearing and speech-impaired and foreign language translation for non-English speaking members.
Specialty care provider responsibilities
Care by specialists will be provided after a referral has been made by the Member’s Primary Care Provider. It is the responsibility of the specialist’s office to ensure that the Member has a valid referral prior to rendering services. Aetna Better Health Medicaid and CHIP network specialists must:
- Be licensed to practice in the State of Texas
- Have admitting privileges at an Aetna Better Health participating hospital
- Obtain a referral from the member’s Primary Care Provider. Or, for services on the prior authorization list, approval from the Aetna Better Health Medical Management Department before rendering services
- Assure that the consultation report and recommendations are sent to the Primary Care Provider and communicate with the Primary Care Provider regarding the Member’s status and course of treatment
- Inform the Member and/or family of the diagnostic, treatment and follow-up recommendations in consultation with the Primary Care Provider (if appropriate)
- Provide Members/families with appropriate health education in the management of the Member’s special needs.
Provider Relations Contact Information:
Medicaid STAR Kids:
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If you are interested in joining our quarterly Provider Advisory Committee meetings, please complete the form below. We look forward to hearing from you.
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