Monthly Archives - September 2017

HEDIS Spotlight: Antidepressant medication management

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, [...]

Provider Alert! 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 visit the TMHP website to review 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 [...]

Improve maternal health outcomes through immediate postpartum LARC insertion

Immediate postpartum Long Acting Reversible Contraception (LARC) insertion refers to the insertion of an intrauterine device (IUD) in the delivery room immediately after delivery of the placenta, or insertion of an IUD or subdermal contraceptive implant prior to hospital discharge. LARCs are beneficial to subsequent maternal health outcomes as they enhance family planning and safer birth spacing.   The postpartum period is a convenient opportunity to initiate LARCs, especially given the engagement of women with health care services during this time. [...]

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 availability standards OB/GYN ·       Emergency services   ·       Urgent condition   ·       Prenatal care for initial appointments   ·       Prenatal [...]

Prior Authorization of Texas Health Steps (THSteps) dental therapy under general anesthesia for members who are six years of age or younger

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 [...]

Provider Alert! Benefit Changes Prior Authorization Update

Attention: All Texas Children’s Health Plan Providers Subject: UPDATE to Changes for Physical, Occupational, and Speech Therapy Benefits   Prior Authorization Changes Update Changes to TCHP Prior Authorizations for PT, OT, and ST services: For therapy authorizations with approved dates of service spanning the 9/1 transition date, TCHP created a revised authorization in our system that reflects the new billing structure using the same authorization number. For all therapy requests that were submitted prior to 9/1, the revised authorization will start on 9/1 and cover through the end [...]

HHSC Hurricane Harvey Information for Providers

HHSC has created new resources for Providers to remain informed about Hurricane Harvey: Hurricane Harvey Medicaid and Children’s Health Insurance Program (CHIP) - Frequently Asked Questions Hurricane Harvey Information for Providers Website - Click here

Provider Alert! CHIP Co-Payments

Attention: All Texas Children’s Health Plan Providers Subject: CHIP- Co-Payments On Thursday, August 31, 2017, the Centers for Medicare and Medicaid Services (CMS) approved the state's request to waive Children’s Health Insurance Program (CHIP) co-payments for members with a permanent address in one of the Hurricane Harvey Federal Emergency Management Agency (FEMA) declared disaster counties. FEMA-declared disaster counties for Hurricane Harvey may be accessed here: https://www.fema.gov/disaster/4332. Co-payments are waived for services provided August 25, 2017 through November 30, 2017. Therefore, providers must not require [...]