Monthly Archives - January 2019

Help your patients keep their New Year’s resolutions in 2019!

Texas Children’s Health Plan offers two programs that can help your patients stick to their New Year’s resolutions well into 2019! The Keep Fit program is available to STAR and CHIP patients ages 10-18 with a BMI of 20+. This program helps kids learn fun, easy ways to stay active and make smart food choices. It offers health coaching, four health and fitness sessions, at-home workout materials, and a quarterly newsletter – all at no cost to the member’s family. [...]

What does Service Coordination mean for your STAR Kids patients?

As a provider, you may have questions regarding the role Service Coordination plays in the lives of our STAR Kids members. At Texas Children’s Health Plan, the goal of Service Coordination is to optimize health to ensure that the member’s tomorrow is better than his or her today. Service Coordination is a person-centered approach to care and each of our members is assigned an appropriately licensed Service Coordinator. In order for that to happen, our Service Coordinators are responsible [...]

What is the Medically Dependent Children’s Program (MDCP) Waiver?

If you have STAR Kids patients, there’s a chance some of them receive the Medically Dependent Children’s Program (MDCP) waiver, which is a home and community based services program. The goal of this program is to support families and children by preventing institutionalization and hospitalization, while helping them remain safely in their homes with the appropriate services. Examples of these services include flexible family support service, respite, minor home modifications, adaptive aids, transition assistance services, employment assistance, supported employment, [...]

Dr. Katy Ostermaier joins Texas Children’s Health Plan as Medical Director for STAR Kids

This past fall, Texas Children’s Health Plan was thrilled to welcome Dr. Katy Ostermaier as the new Medical Director for STAR Kids. Dr. Ostermaier joins us from Texas Children’s Hospital, where she started the Special Needs Primary Care Clinic and served as the Clinic Chief for the Spina Bifida Clinic and the Down Syndrome Clinic. She completed medical school and her pediatric residency at Baylor College of Medicine, where she joined the faculty after completing her training. Dr. Ostermaier [...]

Provider Alert!

Provider Alert! Follow-up on Billing Provider Taxonomy Claims Requirement Effective September 1, 2018

Clearing House Process Verification: Please verify with your clearing house that the TMHP attested billing provider taxonomy is being transmitted on claims for all products. Through collaborative work with provider groups, it has been identified that some clearing houses have been removing the billing taxonomy code on claims prior to submitting to the health plan for processing resulting in claims denials. Billing provider taxonomy is a requirement effective 9/1/2018. Because providers use a variety of clearing houses for claims submission, your [...]

Identifying and treating Seasonal Affective Disorder (SAD)

Season affective disorder (SAD) is a type of depression that appears related to seasonal changes. This recurrent depression may happen every year and occurs most commonly in the fall and winter when the daylight hours shorten, but it may also occur in the spring and summer. SAD may affect up to 5% of the population and seems to be more common in Northern climates and in individuals with a personal history of depression and those with a close relative [...]

Reminder: Tdap Vaccine Coverage for CHIP Perinatal Members

This reminder is to ensure that all providers are knowledgeable on which vaccines are covered for CHIP Perinatal (CHIP-P) members. Based on guidance from the Centers for Disease Control and Prevention (CDC), American Academy of Pediatrics (AAP), and American College of Obstetricians and Gynecologists (ACOG), the Tetanus, Diphtheria, and Acellular Pertussis (Tdap) vaccine is routine prenatal care and is covered in CHIP-P. As noted in the ACOG committee opinion: “The overwhelming majority of morbidity and mortality attributable to pertussis infection occurs [...]

Provider Alert!

Provider Alert! TCHP Prior Authorization Requirement

Effective January 1, 2019, TCHP will be updating the prior authorization listing. Please note there are some key changes for providers. Removed from the list and will no longer require prior authorization: Baclofen Pump New to the list: Home Telemonitoring Updates: Ambulance (non-emergent transport) has been updated to Non-Emergency Ambulance Transport. Augmentative Communication Device has been updated to Augmentative Communication Device and Accessories. Chemotherapy non-FDA approved has been updated to Non-FDA approved medications. Cranial Molding Orthosis (Helmets) has been updated to Cranial Molding Orthosis. High cost (>$50,000) injectable in the [...]

Provider Alert!

Provider Alert! Texas Standard Prior Authorization Request Form compliance grace period has ended

Starting January 1, 2019, the 90-day grace period for compliance with the exclusive use of the Texas Standard Prior Authorization Request Form has ended. From this date forward, providers must use the Texas Standard Prior Authorization Request Form, which can be found at: https://www.texaschildrenshealthplan.org/for-providers. Click on Downloadable Forms on the left-hand side, then click Standard Prior Authorization Form or Behavioral Health Authorization Form to download. As a reminder, the following essential information is required to start the authorization process: Member Name, Member [...]