Monthly Archives - May 2019

Appointment Availability Standards for Specialty Care and Behavioral Health

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.

The YES Waiver for Medicaid Members: What You Need to Know

What is the YES Waiver? The Youth Empowerment Services (YES) Wavier is a Medicaid program that helps youth ages 3-18 years old with serious developmental, emotional, and behavioral difficulties. The YES waiver provides intensive services delivered within a strengths-based team planning process called wraparound. Wraparound builds on family and community support to build a family’s natural support network and connection with the community. The goal of the YES Waiver is to prevent out of home placement. It is a short-term [...]

Provider Alert!

Provider Alert! DME/Supplies Exceeding Medicaid Limitations

Texas Children’s Health Plan applies benefit limitations for DME Supplies and Equipment per the current TMHP Manual for all members eligible to receive the benefit. See benefit exceptions below. Frequency of Billing As a reminder, DME monthly limits will be applied every 27 days. Claims for recurring DME rentals and/or monthly disposable supplies billed prior to this renewal date are subject to denial.  Denied claims may be appealed through the standard appeal process with supporting documentation to establish and/or support medical [...]

Provider Alert!

Provider Alert! Health Insurance Portability and Accountability Act (HIPAA) Compliant Reasons for Denials and Adjustments

Attention:  All Providers Health Insurance Portability and Accountability Act (HIPAA) Compliant Reasons for Denials and Adjustments   Beginning May 15, 2019, Texas Children’s Health Plan (TCHP) providers will see positive changes to their HIPAA standard 835 electronic remittance and paper explanations of payments (EOPs). TCHP will be providing more robust and HIPAA compliant messages by utilizing national standard claim adjustment reason codes (CARCs) and remittance advice remark codes (RARCs). What are CARCs and RARCs? CARCs and RARCs are industry standard code sets used to [...]

Perspectives on E-Cigarettes Webinar

If you take care of children in your practice, or have children of your own who are or will be teenagers, check out the American Thoracic Society’s latest webinar on e-cigarettes: “Perspectives on E-Cigarettes”. Presented by toxicologist Dr. Ilona Jaspers, PhD, this webinar will: Equip you with knowledge and strategies to deter teenagers from nicotine addiction and Provide helpful information on adolescents and e-cigarette use that you can incorporate into your practice Click here to view the webinar now!

Prior Authorization Reference Information

The Texas Children’s Health Plan website now has an additional resource for information related to prior authorization requirements. The Prior Authorization Reference Information documents the codes that require authorization for payment based on authorization category. This list is not yet all-inclusive. It can be found at: https://www.texaschildrenshealthplan.org/sites/default/files/pdf/PA%20Code%20List%20December%202018.pdf In addition, providers can submit an authorization request online for the codes listed on the Prior Authorization Reference Information document via Clear Coverage. For access to or training on the use of Clear [...]

May is Mental Health Awareness Month

May is Mental Health Awareness Month Year after year, more and more Americans face the reality of living with a mental illness. Despite their age, many young children show early signs of mental illness. These mental health problems are often clinically diagnosable, and can be a product of the interaction of biological, psychological, and social factors. “Half of all mental health disorders show first signs before a person turns 14 years old, and three quarters of mental health disorders begin [...]

May 30 CME “Autism — Not Just a Checklist”

Save the date Texas Children’s Health Plan Grand Rounds CME Series Autism – Not Just a Checklist Target Audience: Texas Children’s Health Plan contracted behavioral health providers. Educational methods will include lectures with question and answer sessions. This activity is approved for a maximum of 2.0 AMA PRA Category I Credit(s). Thursday, May 30, 2019 5:30 p.m. Registration and Dinner 6 p.m. Scientific Session Activity Director: Lia Rodriguez, MD, FAAP Medical Director, Texas Children’s Health Plan Speakers: Bob Voigt, MD Chief of Services, Developmental Pediatrics Director, Autism Center, Texas Children’s [...]

The new and improved Provider Portal is here!

The upgraded Texas Children’s Health Plan Provider Portal is now live! We have worked to bring a revamped user experience to our entire provider network. Our goal is to empower our providers with the tools to access accurate, timely data, so that they are able to deliver the best possible care to our members and their families. The redesigned portal features: Improved functionality for the claims, appeals, and messaging center Health Management Tools menu Access to Healthcare Effectiveness Data and Information Set (HEDIS®) [...]