Monthly Archives - May 2017

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:

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 [...]

Zika Prevention: Mosquito Repellant Benefit Now Available

What the mosquito repellent benefit? Texas Children’s Health Plan now covers select mosquito repellents for eligible members to prevent contraction of the Zika virus. This benefit is covered through Texas Children’s Health Plan’s prescription benefits at no cost to eligible members. Which Texas Children’s Health Plan members are eligible for this benefit? Females ages 10-55 years Pregnant women of any age Males ages 14 years and older Does an eligible member require a prescription to receive mosquito repellant? No. The Texas Medicaid Medical Director [...]

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.

Provider Portal Access and Use

Each provider office is assigned an office manager for the purpose of managing the Texas Children’s Health Plan Provider portal. The office manager role is to ensure new staff who need access are assigned the correct security role, as well as to remove any employee who no longer needs access. As a reminder, the responsibility for protecting the HIPAA information within the Texas Children’s Health Plan Provider portal is solely held by each office. Office managers who need assistance with [...]

Join Us For a Member-Provider Collaborative on Interconception Care

This is a chance to interact with members outside the office in a relaxed setting. What: Member-Provider Collaborative Event On Interconception Care When: Thursday, June 8, 201, 12 p.m. to 2 p.m. Where: The Center for Children and Women-Southwest, 9700 Bissonnet, Houston, TX 77036 RSVP by May 26 to Diane Nunez Email: Phone: 832-828-1430 Lunch will be served!