Monthly Archives - December 2017

HEDIS Spotlight

HEDIS® (Healthcare Effectiveness Data and Information Set) is a widely used set of performance measures that ensures our members are getting the best health care possible. It is extremely important that our providers understand HEDIS® specifications and guidelines. This section highlights different HEDIS metrics in addition to providing descriptions of the measures, correct billing codes to support services rendered, and tips to direct you to corresponding resources and tools.   MEASURE: FOLLOW-UP AFTER HOSPITALIZATION FOR MENTAL ILLNESS MEASURE DESCRIPTION: Members 6 years [...]

Smoking cessation available for parents and caregivers

Smoke-free homes lead to better health outcomes and reduced ED admissions for patients with asthma. Texas Children’s Health Plan provides free smoking cessation counseling and nicotine replacement products for the parents and caregivers of members with asthma. As a provider, you can help your patients more by supporting smoking cessation for parents and caregivers. If your practice site is interested in learning how to enroll parents/caregivers in this program, please contact Texas Children’s Health Plan’s Care Coordination team at [...]

RSV Season and Synagis (palivizumab)

RSV season is here! Season schedules are established at the recommendation of the Texas Pediatric Society's RSV Task Force group. RSV seasons by region can be found here: Texas Children’s Health Plan authorizes palivizumab based on criteria determined by the 2014 American Academy of Pediatrics recommendations. Texas Children’s Health Plan’s prior authorization form can be found here: For the 2017-2018 RSV season, Texas Children’s Health Plan will continue to use the following 2 preferred pharmacies: Maxor Specialty Pharmacy 216 South Polk [...]

Provider Responsibilities

As a reminder, demographic changes must be sent in writing to Texas Children’s Health Plan within a minimum of 30 calendar days. Changes not received in writing are not valid. Texas Children’s Health Plan and its designated claims administrator are not responsible for potential claims processing and payment errors due to failure to update information. Notification of change should be made to Texas Children’s Health Plan Provider Relations and Care Coordination at the following email address:, or by [...]

Important Formulary Changes (Effective January 1, 2018)

Texas Children’s Health Plan formulary, preferred drug list, and prior authorization  forms can be found here: Questions? Contact the Navitus Pharmacy Benefits Customer Care Team at 1-877-908-6023.

ADHD Provider Tool Kit

What is it? Texas Children’s Health Plan is pleased to announce the unveiling of the ADHD Provider Toolkit. This online resource went live in mid-November. The ADHD Provider Toolkit is a go-to site for a wide range of relevant material to assist clinicians in the diagnosis, treatment, and management of patients with ADHD and their families. The goal is to provide information sources for the primary care provider who frequently sees patients with this diagnosis, thereby making evidence-based practices and [...]