Required Documents
for Patients with Medicaid
This page is for patients who have Cook Children Medicaid STAR or CHIP. For patients with Aetna Medicaid, Amerigroup Medicaid, or Traditional Medicaid please complete at least item 1, and call us at 214-302-9725 to schedule an evaluation.
This content on this page is meant to be informative and to assist patients in navigating the Prior Authorization process for obtaining speech therapy services. This information was not created by Texas Medicaid or any Managed Care Organization associated with Texas Medicaid.
In order to obtain services, Medicaid requires that a child's primary care physician remains central to the entire process. Therefore, any requests for a speech therapy evaluation or speech treatment must pass through your child's physician. Medicaid requires the following:
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Doctor referral/prescription from a well child visit or THSteps Exam completed in the last 60 days that documents a need for speech therapy. Please ask your doctor's office to fax this to 214-935-2457 prior scheduling your appointment.
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A developmental screener, such as the ASQ or PEDS, completed at your child's physician's office (if your child is less than 8 years old). Please ask your doctor's office to fax this to 214-935-2457.
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A hearing screening or hearing evaluation that documents normal hearing in at least one ear through pure tone audiometry in the last year (if your child is older than 3) or within the last 6 months (if your child is younger than 3). Please ask your audiologist or otolaryngologist (ENT) to fax to 214-935-2457. A hearing evaluation completed at the pediatrician office may count towards this requirement.
Getting the hearing appointment can take time. We recommend that you ask for a referral for a hearing test at the same time that you call and schedule your child's doctor's appointment to reduce any chance of a delay.
Once these items are completed. Please call us at 214-302-9725.
We will ask your PCP to fax the Well Child visit results, the ASQ/PEDS, the results from the hearing screening and the referral to us in order to complete the prior authorization form. We will then send it for final signatures from your child's primary care physician.
After the steps above have been completed, we will contact you to schedule an evaluation.