Monthly Archives - January 2018

Provider Alert!

Provider Alert! EVV Prospective Process: what is it?

Attention:  All TCHP STAR Kids LTSS Providers Requiring EVV Subject:  TCHP EVV Prospective Process   Beginning 05/01/2018, Texas Children’s Health Plan will activate the Prospective Process for the EVV system. This process will match claims to EVV transactions prior to the claim being paid. If a matching EVV transaction is not found, the claim will be denied. It is imperative that all providers ensure that all members have the correct payor ID set up in the EVV software. If a member does [...]

ADHD Provider Toolkit

What is it? Texas Children’s Health Plan is pleased to announce the unveiling of the ADHD Provider Toolkit. 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 tools available on the desktops of busy [...]

Well Child Visits – Provider Incentive Program HEDIS measure has changed

Providers will now be measured on W156, well-child visits in the first 15 months of life (6 or more visits). Members assigned to your panel within the designated age range are eligible in January. Tell your Texas Children’s Health Plan patients that they can get up to 2 free packs of disposable diapers for completing their 12-month and 15-month well-child checks! Limit 1 pack of diapers per visit. Well-child visits are part of important HEDIS (Healthcare Effectiveness Data and Information Set) [...]

Training for Providers on Child Development Screening and Surveillance

The Child Developmental Screening and Surveillance web training is available on the Texas Health Steps Online Provider Education website: The goal of this module is to equip Texas Health Steps providers and others with the skills to conduct developmental surveillance and screening during preventive medical checkups for children birth through 6 years; use approved screening tools; make appropriate referrals; and coordinate care in the primary care setting. Continuing education units are available for physicians, nurses, social workers, and Certified Health [...]

Save the Date February 8 CME

Save the Date Grand Rounds CME Series Hanging in the Balance: Ethics Perspective on Hospice Care & Provider Burn Out Provided by Texas Children’s Hospital and presented by Texas Children’s Health Plan   ACTIVITY DIRECTOR: Lia Rodriguez, MD, FAAP Medical Director, Texas Children’s Health Plan SPEAKERS: Tammy Kang, MD, MSCE Associate Professor of Pediatrics, Palliative Care, Baylor College of Medicine – Houston, TX Stacey R. Rose, MD, BA Associate Director, Assistant Professor, Internal Residency Program, Baylor College of Medicine – Houston, TX   Thursday, February 8, 2018 5:30 p.m. Registration & Dinner 6:00 p.m. - [...]

Reminder on obtaining an authorization for genetic testing

Quest Diagnostics is the exclusive contracted lab for TCHP. For OB providers, all genetic testing requires prior authorization. Link to all services that require prior authorization:

Newborn Hearing Screening Requirement

A newborn hearing screening must be completed at the birthing facility. Automated auditory brainstem response (AABR) or transient evoke or distortion product otoacoustic emissions (OAE) may be performed. If an infant is not born in a birthing facility and is not admitted to a birthing facility, the infant must be referred to a facility that provides newborn hearing screening. Newborns who do not pass the initial screen must be rescreened a second time in the birthing facility before discharge. Screening Results Birthing facilities [...]

A suitable timeline for prenatal and postpartum care

Timely prenatal and postpartum care is an important component of successful health outcomes for women and their babies, as well as a measure of quality care. Prenatal visit The first prenatal visit must be rendered in the first trimester or during the first 42 days of enrollment into the health plan to meet the standards set forth by Healthcare Effectiveness Data and Information Set (HEDIS). Postpartum visit In order for the visit to qualify as a postpartum visit, it must include documentation in [...]