Monthly Archives - March 2017

Provider Alert!

Provider Alert! Prior Authorization Changes Coming

Attention: All TCHP Providers Subject: TCHP Prior Authorizations TCHP will be updating the services requiring a prior authorization effective April 1, 2017. Please note there are some key changes to make providers aware of. Physical Therapy, Occupational Therapy and Speech Therapy re-evaluations will no longer need to be prior authorized. The CPT codes for these services are: 97164, 97168, S9152 Spinraza(Nusinersen) has been added as a Medical Benefit by TMHP. Spinraza(Nusinersen) will require a prior authorization. TCHP will follow TMHP coding guidance located at A new TCHP [...]

Provider Alert!

Provider Alert! Epaned (enalapril oral solution)

Attention: Texas Children Health Plan Providers  Subject: Epaned The manufacturer of enalapril oral solution (Epaned) changed the formulation from a powder for reconstitution to a prepared oral solution. The powder for reconstitution has been discontinued and the oral solution is not yet on the Texas VDP formulary. VDP is currently reviewing the new formulation to be added to the Texas VDP formulary. Until this issue is resolved, options for providers are: Find a pharmacy with the old Epaned (enalapril oral solution) product [...]

Meet Our New President

Lou Fragoso has been appointed president of Texas Children’s Health plan. He joined Texas Children’s Pediatrics in February 2014 and was vice president of Business Operations. Prior to joining Texas Children’s, Lou was in leadership roles at Baylor College of Medicine in Houston and at Lurie Children’s Hospital in Chicago. Lou is a Certified Public Accountant with over 20 years of healthcare finance and management experience. Since joining Texas Children’s Pediatrics, Lou spearheaded the creation of Texas Children’s Urgent Care. [...]

New Texas Children’s Health Plan provider portal features added

Texas Children’s Health Plan has been actively adding new features to the provider portal located at Providers can continue to view eligibility, claim status, authorizations and all of our provider news. In addition, providers are able to view the named Service Coordinator for STAR Kids members and submit claim appeals online. The named Service Coordinator for STAR Kids members can be found on the member enrollment information screen under additional information. The Texas Children’s Health Plan Service Coordinator serves as [...]

Attention: Star Kids Providers: Prior Authorization required on all Vendor Drug Program (VDP) identified medications

Texas Children’s Health Plan requires prior authorization (PA) on all medications on the VDP website prior to dispensing to members. To obtain a list of medications requiring prior authorization, visit the VDP website at: Providers can also view instructions on accessing and using the formulary at the Texas Children’s Health Plan website: Providers can submit PA documentation to Texas Children’s Health Plan’s pharmacy benefit manager, Navitus. PA forms can be found here: Prior authorizations need to be submitted to Navitus by faxing [...]

Provider Alert!

Provider Alert! LTSS Provider Claims Request

Attention Long Term Services and Supports Providers Texas Children’s Health Plan would like to ensure that we have received all your claims from November 1st 2016, the program start date for STAR Kids. If you should have any questions related to claim submission and/or billing requirements, please contact Provider Relations at 1-800-731-8527. Your  Provider Relations team is prepared to guide you through the billing standards necessary to accurately bill Texas Children’s Health Plan and receive your payments timely. The Texas Children’s Health [...]