Monthly Archives - September 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.   PLEASE NOTE: Specialist visits do not require primary care provider (PCP) referral.

Provider Alert!

Provider Alert! Information for Members on Recent Storm

Dear Providers, The services you provide to our members are important and during this time of inclement weather, we want to make accessing health care as easy as possible. Please find important details to assist you below.  This information only applies to members located in the impacted counties as outlined. Impacted Counties:  Brazoria, Chambers, Galveston, Hardin, Harris, Jasper, Jefferson, Liberty, Matagorda, Montgomery, Newton, Orange, and San Jacinto Important Things to Know: Prior authorizations are waived for medically necessary procedures and treatments including service [...]

Provider Alert!

Provider Alert! Initial specialty therapy evaluations no longer require an authorization but do require current Texas Health Steps checkup or attestation

Date: September 19, 2019 Attention: All Providers Subject:  Amended:  Initial and Ongoing Specialty Therapy Treatment- Current Texas Health Steps Checkup or Attestation required Effective Date: September 19, 2019 Call to action: Initial specialty therapy (occupational, physical, speech therapy) evaluations do not require prior authorization effective September 1, 2019. However, a current Texas Health Steps checkup performed in the last 12 months or a current well checkup attestation is required for ongoing specialty therapy lasting for greater than 60 days. How this [...]

Provider Alert!

Provider Alert! Reporting Provider Office Closures due to Recent Storm

Dear Providers, The severe weather experienced recently may have affected your ability to operate during normal business hours.  If you are unable to provide services to our members at this time, please contact us via the Provider Portal Message Center and select the “General Health Plan Questions” as the recipient.  Be sure to include any changes to your business hours and/or location and the TCHP Provider Network Management Department will follow-up with you. Thank you for your continued support and the [...]

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 your STAR Kids patients. 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. Each of our members is assigned an appropriately licensed Service Coordinator. Our Service Coordinators are responsible for the following: Providing each member with initial [...]

Provider Alert!

Provider Alert! Respite Care Services

Call to action: Texas Children’s Health Plan (TCHP) offers a respite care value-added service for STAR Kids members.  Respite care provides temporary relief for parents or legally authorized representatives who are caring for a child with special needs.  TCHP offers 24 hours of in-home respite care service per calendar year as an extension of home and community-based services. How this impacts providers: This value-added service applies to TCHP STAR Kids members that are not already receiving respite care services through [...]

Provider Alert!

Provider Alert! Update: Prior Authorization Requirements

Please note the following key prior authorization requirement changes for providers. Updates: Effective July 1, 2019 Psychological testing (procedure codes 96130, 96131, 96136, and 96137), neurobehavioral testing (procedure codes 96116 and 96121), and neuropsychological testing (procedure codes 96132, 96133, 96136, and 96137) are limited to four hours per member, per day and eight hours per member, per calendar year. Prior Authorization will not be required when billed within these limits. Additional hours require prior authorization. Botulinum toxin injections will only require authorization [...]

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 care Minor home modifications Adaptive aids Transition assistance services Employment assistance Supported employment Financial management services The purpose of enrolling a [...]