Monthly Archives - June 2017

Provider Alert!

Provider Alert! Authorization Extension for STAR Kids Members (Revised)

The Health and Human Services Commission (HHSC) expects managed care organizations to extend longterm 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 compliance with HHSC’s guidance and as required by the STAR Kids contract, STAR Kids managed care organizations must assess each enrolled member by completing the STAR Kids Screening and [...]

Provider Alert!

Provider Alert! Nasonex

Effective July 27, 2017, Nasonex will be reclassified from preferred to non-preferred. Fluticasone nasal will be the only preferred intranasal corticosteroid for allergic rhinitis. Patients requiring Nasonex on or after July 27, 2017 will require a prior authorization. Prior authorization forms can be found here: Questions? Please contact Navitus at 1-877-908-6023.

Provider Alert! Codeine and Tramadol should NOT be prescribed for children

On April 20, 2017 the US Food and Drug Administration (FDA) issued a statement that CODEINE is CONTRAINDICATED for treatment of pain or cough for children under 12 years. The also WARN against its use in adolescents 12-18 years old, especially those with obesity, obstructive sleep apnea, or severe lung disease.   The FDA considers TRAMADOL to be CONTRAINDICATED for children younger than 18 to treat pain from tonsillectomy or adenoidectomy.   Note that Tramadol is not FDA approved for use [...]

Are oral steroids being overused for children with asthma?

Oral corticosteroids have been shown to definitively benefit children with moderate to severe asthma exacerbations. However, they show no benefit and even possible harm for children with 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 past year for children with a diagnosis of asthma: close to 50% for children under 5 years, and close to 40% of children over 5 years. There was large variation [...]

Zika Virus Testing Requires Modifier U4 on Claims

Information posted May 5, 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 May 5, 2017, laboratory providers must include modifier U4 with procedure code 86790, 87798, or 87799 when submitting a [...]

Texas Becomes 4th State to Launch Universal Baby Box University Program to Equip New Parents to give their Babies a Healthy Start in Life

Encourage your patients to be a part of the Baby Box movement, which promotes safe sleep for infants! Texas has become the 4th state to launch Baby Box University, which helps new parents give their babies a healthy start in life. The Baby Box program is designed to encourage mothers to get prenatal care and promote a good relationship between moms-to-be and their doctors. By completing an online syllabus through the company’s educational platform, Baby Box University, all new and [...]