Monthly Archives - May 2017

Provider Alert!

Provider Alert! New Fax Number for STAR Kids Private Duty Nursing Prior Authorization

Attention STAR Kids Providers Texas Children’s Health Plan New Fax Number for STAR Kids Private Duty Nursing Prior Authorization To expedite the prior authorization process for Texas Children’s Health Plan for STAR Kids, please begin faxing to 346-232-4757 for outpatient prior authorization for the following service. Private Duty Nursing The Prior Authorization Request Form is conveniently located on the STAR Kids website at Please contact your dedicated Provider Service Representative toll-free at 1-800-731-8527 with any questions. Thank you for your commitment to your Texas Children’s [...]

The Texas Clinician’s Postpartum Depression Toolkit

A new resource for screening, diagnosis and treatment of postpartum depression. Click here to view this helpful resource for postpartum depression:

Provider Alert!

Provider Alert! Enrollment Information for CHIP Providers

Attention CHIP Providers Enrollment Information Specific to CHIP Providers Federal law and regulation require states to screen and enroll all network providers including Children’s Health Insurance Program (CHIP) providers by December 31, 2017. To meet this requirement and continue receiving reimbursement for services, providers who currently render services to CHIP members through (Texas Children’s Health Plan) must complete enrollment with the Texas Medicaid & Healthcare Partnership (TMHP) by December 31, 2017. While the enrollment process and application are the same for Medicaid [...]

Provider Alert!

Provider Alert! STAR Kids Billing Matrix

Attention STAR Kids Providers Effective 06/05/2017 Updated STAR Kids Billing Matrix The STAR Kids billing matrix has been updated to include the registered nurse modifier (TD) to the private duty nursing (PDN) billing code, T1000. Additionally, the billing codes for PDN independently enrolled LVNs and RNs have been added to the matrix. The Revenue Code 663 was added to the Out-of-Home Respite codes. This billing matrix will become effective for dates of service June 5, 2017 and forward. Failure to use [...]

TCHP now accepts Outpatient Authorizations for many services online via Clear Coverage effective June 1, 2017!

Tired of faxing authorization requests and medical records? Spending too much time on hold waiting to speak to an Authorization Specialist for non-urgent authorization request? Looking for a faster, more efficient way to submit authorizations? Why not submit your authorizations request through Clear Coverage? What are the benefits? Easy to access 24/7 online access to Clear Coverage Receive real time authorization status by viewing your office’s home page in Clear Coverage Services are immediately uploaded into Texas Children’s Health Plan’s authorization for clinical review Automatic APPROVALS may [...]

Provider Alert! Authorization Extension for STAR Kids Members

Attention STAR Kids Providers May 17, 2017 Authorization Extension for STAR Kids Members The Health and Human Services Commission expects managed care organizations to extend long term services and supports (such as Personal Care Services, Community First Choice, and Private Duty Nursing) authorizations for services until completion of the STAR Kids Screening and Assessment Instrument (SAI), but no longer than July 1, 2017. In order to receive payment for these services, you must have authorization from Texas Children’s Health Plan, and the SAI must be completed [...]

Telehealth Benefits to Change for Texas Medicaid June 1, 2017

Information posted April 14, 2017 Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, pre-certification, referrals, and claims/encounter data filing may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the client's specific MCO for details. Effective for dates of service on or after June 1, 2017, telehealth benefits will change for Texas Medicaid. Overview of Benefit Changes Major changes to this [...]

No Prior Authorizations Required for Texas Children’s Health Plan (TCHP) In-Network Observations

1. In-network Observation stays do not require prior-authorization. 2. Hospital stays that include less than two bed days (less than “two midnights”) at the time of submission will be categorized as Observation Level of Care with some exceptions: a. Obstetrical deliveries b. Patient deaths c. Against Medical Advice (AMA) discharges d. Intensive Care Unit (ICU) admissions e. Pediatric Intensive Care Unit (PICU) admissions f. Pediatric Progressive Care Unit (PCU) g. Initial Neonatal Intensive Care Unit (NICU) admissions h. Neonatal Intensive Care Unit (NICU) readmissions within 28 days i. Behavioral [...]

Are Oral Steroids being overused for children with asthma?

Oral Corticosteroids have been shown to have definite benefit for children with moderate to severe asthma exacerbations, but no benefit and possible harm for minimal to mild exacerbations.  Recent research using data from Texas Children’s Health Plan has found very high rates of oral corticosteroid dispensing in the prior year for children with a diagnosis of asthma – close to 50% for children under 5 years, and close to 40% of children with asthma over 5 years.  There was [...]

Verify Eligibility Monthly

As a reminder, members who have STAR and STAR Kids may change their managed care plans monthly. Providers should routinely verify eligibility with Texas Children’s Health Plan for membership by visiting our Texas Children’s Health Plan Provider portal at\providers. The Provider portal has the most current information specific to Texas Children’s Health Plan. If you have questions regarding the Provider portal, please contact Texas Children’s Health Plan Provider Relations at 800-731-8527.