Monthly Archives - August 2017

Provider Alert! Adoption Assistance

Subject: Adoption Assistance Attention all Texas Children’s Health Plan providers: Effective 09/01/2017 Adoption Assistance members are required to enroll in managed Medicaid and will be new members with Texas Children’s Health Plan STAR or STAR Kids programs. For Continuity of Care, Texas Children’s Health Plan will receive authorizations from TMHP for Adoption Assistance services on Texas Children’s Health Plan members, effective September 1, 2017. Texas Children’s Health Plan will honor all existing authorizations until expiration or end of 90 days after [...]

Provider Alert! Financial Management Service Agency (FMSA)

Subject: Financial Management Service Agency(FMSA) Registration is now open for the Annual Financial Management Service Agency (FMSA) training scheduled for September 19, 2017, 8:30am-5:00pm. This training is mandatory for FMSAs per contracting requirements in Texas Administrative Code, Rules 41.301 and 49.302. In order to comply with this requirement. This required training is now offered in two formats: the FMSA may choose to either attend in-person or by webinar. The in-person training will be at the Winters building located at 701 W. 51st St., Austin, [...]

Appointment Availability Standards

What are appointment availability standards? How do you as a provider with Texas Children’s Health Plan play a role? In 2015 Senate Bill 760 passed, requiring Texas Health and Human Services Commission (HHSC) to monitor the provider networks of managed care organizations. Texas Children’s Health Plan would like to ensure members are able to schedule appointments with providers in accordance with the HHSC’s appointment accessibility guidelines.   Provider Type Level/Type of Care Appointment Accessibility Standards OB/GYN Low Risk Pregnancies Provided within 14 calendar days High Risk Pregnancies Offered within 5 [...]

Reimbursement code for sports and camp physicals

Effective January 1, 2017, Texas Children’s Health Plan began reimbursing code 97169 – Athletic Training Evaluation, low complexity, as a value added service to CHIP and STAR Members under 21. This code is only reimbursed for sports and camp physicals when a member has also had a THSteps or well child visit within the previous 12 months. Code 97169 will be the only code that is accepted for reimbursement; use of any other Athletic Training Evaluation code (such as [...]

Protect newborns from pertussis: immunize with Tdap today

Tdap vaccination is a covered benefit for all pregnant women who are Texas Children’s Health Plan members. Prenatal office visits are the best place for a member to receive this vaccine. It’s important to note that Texas Medicaid does not cover Tdap at the pharmacy. Tdap can be given at any time during pregnancy, but ideally it should be administered between 27 and 36 weeks to maximize maternal antibody response and passive transfer to newborn. CDC surveillance reports that 2-month-old [...]

Appointment Availability Standards

What are appointment availability standards? How do you as a provider with Texas Children’s Health Plan play a role? In 2015 Senate Bill 760 passed, requiring Texas Health and Human Services Commission (HHSC) to monitor the provider networks of managed care organizations. Texas Children’s Health Plan would like to ensure members are able to schedule appointments with providers in accordance with the HHSC’s appointment accessibility guidelines. Provider Type Level/Type of Care Appointment Accessibility Standards OB/GYN Low Risk Pregnancies Provided within 14 calendar days High Risk Pregnancies Offered within 5 [...]

HEDIS Spotlight: Well-child and well-care visits

HEDIS stands for Healthcare Effectiveness Data and Information Set. It is a widely used set of performance measures utilized by the nation’s health plans, and an essential tool to ensure our members are getting the best healthcare possible. It is extremely important that our providers understand the HEDIS® specifications and guidelines. In this section of The Checkup we will highlight different HEDIS metrics. We will provide a description of the measures, the correct billing codes to support services rendered, [...]

Enhance your adolescent care with SBIRT

It’s back-to-school season, a time when pediatrics offices are busy with well-child checks and sports physicals. Pediatricians are in an excellent position to educate adolescents about their health, including providing guidance about substance use. The AAP advises on universal substance use screening using SBIRT techniques for all adolescents. In lower-risk patients, they can prevent or delay the onset of use. For intermediate-risk patients, they can discourage ongoing use and reduce harm. And they can refer patients who have developed [...]