Monthly Archives - June 2019

For STAR Kids providers: Updated ANE Reporting Process

This requirement is effective September 1, 2018, and the updates have now been made in the UMCM – see Resources below.   As of September 1, 2018, all Texas Children’s Health Plan-contracted providers of Medically Dependent Children Program (MDCP) services are required to report all critical incidents, including Abuse, Neglect, and Exploitation (ANE), to the health plan. This action is to meet federal requirements regarding critical incident reporting (see links to federal requirements for incident reporting in below ‘Resources’ section).   MDCP providers [...]

OB/GYN 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.                   **Texas Children’s Health Plan periodically surveys each participating provider to ensure that members are able [...]

Provider Alert!

Provider Alert! Reminder: Texas Children’s Health Plan Claims Editing System (CES) Update

Attention:  All Providers Update: Texas Children’s Health Plan Claim Editing System Texas Children’s Health Plan (TCHP) recently sent a Provider Alert updating our plan to transition to a new Claims Editing System (CES) by Optum on May 31, 2019. Please be advised this transition will now include edits specific to Texas and National Medicaid and the transition will occur in June 2019. This was initially scheduled to be done later in the year as another phase of the project, however [...]

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®) [...]