TX HHS Form H1087. Verification of Texas Health Steps Checkup

Form H1087 is used by the Texas Health and Human Services Commission (HHSC) to confirm whether a child has received an overdue Texas Health Steps (THSteps) medical checkup. This verification is required when paid-claims records show no completed visit, but the child’s caretaker states that the checkup was done by a specific provider. The form helps HHSC coordinate with Texas Health Steps staff to ensure that children receive timely preventive care and that families remain eligible for certain benefits.

Purpose and Use of the Form

The primary purpose of Form H1087 is to verify overdue THSteps checkups for children applying for assistance. It acts as a communication bridge between:

• Texas Works advisors reviewing the family's case,
• Texas Health Steps program staff, and
• Healthcare providers who may have delivered the checkup.

This form is important because preventive medical checkups are required for children receiving Medicaid in Texas. HHSC needs accurate documentation to ensure compliance and maintain eligibility.

Who Has the Right to Complete or Sign the Form

• Texas Works advisors — complete the top section when requesting verification.
• Texas Health Steps staff — provide verification or additional information and sign the worker verification section.
• Parents or guardians — sign the release authorization allowing THSteps staff to obtain medical information from healthcare providers.

Explanation of Each Section

1. Advisor and Office Details

This section identifies the Texas Works advisor requesting verification. It includes:

• Phone and fax numbers,
• Date,
• Office address.

Accurate contact details prevent delays in receiving verification from THSteps staff.

2. THSteps Staff and Coordinator Information

Used by Texas Health Steps program staff to document their contact information when replying. This ensures both agencies can coordinate efficiently.

3. Household and Case Information

Includes the child’s case name, case number, family address, and primary phone number. HHSC uses this information to match the verification request with the correct household.

4. Child Information and Checkup Claim

This is the core of the form. For each child, it records:

• Name and date of birth,
• Medicaid client number,
• Name and contact information of the doctor or clinic the caretaker believes performed the checkup,
• Date of the claimed checkup.

This section is often where errors occur—incorrect provider names, missing dates, or incomplete identifiers can delay verification.

5. THSteps Worker Reply

Texas Health Steps staff verify whether the checkup occurred by reviewing state medical claim systems, provider records, or direct outreach. They note:

• Whether the checkup is verified,
• Whether the family initiated the contact,
• Any relevant comments.

6. Parent Authorization

The parent’s signature grants permission for THSteps staff to access or request medical information needed for verification. Without this signature, verification may be impossible.

When the Form Must Be Submitted

• When state records show a child is overdue for a required THSteps checkup.
• When a caretaker reports that the checkup was completed, but the claim has not been processed.
• When HHSC needs confirmation before approving or continuing certain benefit programs.

When the Form Is Not Required

• If the medical provider has already submitted a claim processed by TMHP.
• If the checkup has not been completed—families must schedule a visit instead of submitting this form.
• When HHSC already has recent verified medical records.

Common Mistakes to Avoid

• Providing the wrong provider name or clinic.
• Leaving the checkup date blank.
• Not signing the parental authorization section.
• Listing outdated phone numbers for follow-up.

Examples of Real-World Use

• A parent claims their child had a checkup at a community clinic, but the claim has not yet appeared in TMHP’s records.
• A family recently moved, and their new provider submitted the claim under a different Medicaid number, causing delays in verification.
• A caretaker insists the required checkup was done but cannot recall the provider’s contact information; HHSC uses this form to investigate.
• A child transitioned from CHIP to Medicaid, and the new program requires confirmation of preventive visits.

Supporting Documents Often Required

• Clinic appointment card or visit summary.
• Provider business card or phone number.
• Medicaid ID number for the child.
• Any written confirmation from the medical provider, if available.

Practical Tips for Completing the Form

• Double-check provider names and phone numbers before submission.
• Ask the clinic for the exact date of the completed checkup.
• Ensure the parent or guardian signs the release section.
• Fax numbers must be current, as most communication is done by fax.
• Include all children who need verification to avoid multiple requests.

FAQ

• What is the purpose of Form H1087? It verifies overdue THSteps checkups when HHSC cannot confirm the visit through claim systems.
• Who completes the form? Texas Works advisors complete the request; THSteps staff complete the verification section.
• Do parents need to sign? Yes. The parent’s authorization is required to release medical information.
• What happens if verification fails? HHSC may require the family to schedule a new THSteps checkup.
• How long does verification take? It depends on provider response and claim processing times.
• Can multiple children be listed? Yes, each child has a separate section in the same form.
• Is this form used for emergency care? No. It is exclusively for preventive THSteps checkups.

Micro-FAQ

• Purpose: To confirm overdue THSteps checkups.
• Who files: Texas Works advisors submit the request.
• Parent role: Authorize release of medical information.
• Verification by: Texas Health Steps staff.
• Attachments: Provider name, date of checkup, child’s Medicaid number.
• Submitted to: Texas Health Steps regional coordinator.
• Used for: Medicaid child preventive care compliance.
• Deadline: When requested during benefit review.
• Multiple children: Yes, each child is listed separately.

Related Forms

• Texas Form H3037 — Child Health Information Release
• Texas Form H1025 — Verification of Employment
• Texas Health Steps Periodicity Schedule Forms
• Texas Medicaid Provider Documentation Forms

Form Details

• Form Name: Verification of Texas Health Steps Checkup
• Form Number: H1087
• State: Texas
• Edition: January 2019