New claim appeal form can be found at http://www.texaschildrenshealthplan.org/for-providers/resources/downloadable-forms Please note that providers must file an appeal within 120 days from the date of the denial for reconsideration.
TCHP now accepts Outpatient Authorizations for many services online via Clear Coverage effective June 1, 2017Texas Children's Health Plan
✔ 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 requests? ✔ Looking for a faster, more efficient way to submit authorizations? Why not submit your authorizations request through Clear Coverage? What are the benefits? Easy, 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 [...]
Grand Rounds CME Series – Provided by Texas Children’s Hospital and presented by Texas Children’s Health Plan Hanging in the Balance: Ethics Perspective on Palliative Care & Provider Burnout Thursday, September 7, 2017 5:30 p.m. Registration and Dinner 6 to 8 p.m. Scientific Session Event will be broadcasted. For Hub Locations, CME program details, and to register go to www.TexasChildrensHealthPlan.org/CME Please note: Registration is free for Texas Children’s Health Plan contracted providers.
Effective May 22, 2017, providers should fax prior authorization forms to 346-232-4757. The form can be found at http://www.texaschildrenshealthplan.org/for-providers/resources/downloadable-forms
Updated STAR Kids billing matrix effective June 5, 2017. Updates include: Registered nurse modifier (TD) to the private duty nursing (PDN) billing code, T1000 Billing codes for PDN independently enrolled LVNs and RNs are included in the matrix Revenue code 663 was added to the out-of-home respite codes. Please note that failure to use this billing matrix will result in denials for incorrectly billed services. For more information on this topic, visit http://www.texaschildrenshealthplan.org/for-providers .
Prior Authorization of Texas Health Steps (THSteps) dental therapy under general anesthesia for members who are six years of age or youngerTexas Children's Health Plan
Effective July 1, 2017, Texas Children’s Health Plan will be required to implement prior authorization for Level 4 deep sedation and general anesthesia provided in conjunction with therapeutic dental treatment for Medicaid dental clients from ages 0 through six years. All Level 4 services must be authorized prior to rendering services. Anesthesia services provided by a dentist should use procedure code D9223. Any anesthesia services provided by an anesthesiologist (M.D./D.O.) or certified registered nurse anesthetist (CRNA), should use procedure code [...]
A common reason for behavioral health readmission is delay to an outpatient supply of antipsychotic medications. You can help avoid this problem by completing prior authorization documentation before a patient is discharged. Texas Children’s Health Plan follows Texas Medicaid Guidelines for the use and approval of antipsychotics in children. Prior authorization documentation for antipsychotic medications can be found here: https://www.navitus.com/Misc-Pages/PDF-Form-Viewer.aspx?FormID=5264d812-b3d9-45f7-9b7a-a48eefca8adc Providers can ensure patients receive antipsychotic medications at discharge by using the hospital pharmacy or a community pharmacy delivery service. If a [...]
Subject: Changes to Physical, Occupational, and Speech Therapy Benefits for All Ages Effective for dates of service on or after September 1, 2017, physical therapy (PT), occupational therapy (OT), and speech therapy (ST) benefits for all ages will change for Texas Medicaid. Please review http://www.tmhp.com/News_Items/2017/06-June/06-30- 17%20Physical,%20Occupational,%20and%20Speech%20Therapy%20Benefits%20for%20All%20Ages%20 to%20Change%20for%20Texas%20Medicai.pdf for changes to this medical benefit policy that applies to the following: Billing structure changes for PT, OT, and ST services Procedure codes end-dating August 31, 2017 Required modifiers Claims filing changes Clarification to benefits Providers may refer to the current Texas Medicaid [...]
Effective for dates of service on or after September 1, 2017, physical therapy (PT), occupational therapy (OT), and speech therapy (ST) benefits for all ages will change for Texas Medicaid. Please review this link for changes to this medical benefit policy that applies to the following: Billing structure changes for PT, OT, and ST services Procedure codes end-dating August 31, 2017 Required modifiers Claims filing changes Clarification to benefits Providers may refer to the current Texas Medicaid Provider Procedures Manual, Physical Therapy, Occupational Therapy, and Speech [...]
Ordering, Referring, and Prescribing Providers Frequently Asked Questions 1) What is the new enrollment requirement for ordering, referring, and prescribing providers? –– Federal regulations at 42 CFR 455.440 require claims for payment of items or services that were ordered, referred or prescribed to contain the National Provider Identifier of the physician or other professional who ordered, referred or prescribed the items or services. Additionally, federal regulation 42 CFR 455.410 requires all ordering, referring or prescribing providers to be enrolled as participating providers [...]