Provider Alert! COVID-19 Disaster Declaration – Prior Authorization Adjustments

Provider Alert! COVID-19 Disaster Declaration – Prior Authorization Adjustments

Attention: All Providers
Effective Date: March 18, 2020

TCHP affiliated providers should monitor the TCHP Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event.

 

As a result of the COVID-19 Disaster Declaration, TCHP has instituted the following:

 

  • In order to increase access to primary care services, TCHP is now waiving prior authorization requirements for out-of-network primary care visits (Pediatrician, Family Practice/General Practice, Internal Medicine, OB/Gyn) an authorization will not be needed for these services while the COVID-19 State of Disaster Declaration is in place.  When the service requested by a Primary Care Provider requires authorization, the service should be reviewed for medical necessity (e.g. genetic testing) as part of the authorization process

 

  • Authorizations requested by out-of-network (OON) providers for other services may be approved when the member is unable to access in-network services during the COVID-19 State of

 

  • LTSS service authorizations expiring in March will be extended for 120 days and those expiring in April will be extended for 90 days.

 

  • TCHP will approve extensions of existing authorizations for services when the provider states that the member was unable to access services while the COVID-19 State of Disaster is in place. Authorization extension can be given 30 days at a time.

 

  • For LTSS, PDN, therapy, and DME services, TCHP may waive the “change of provider” letter requirements and approve changes of a previously approved or authorized provider at the provider/member request without formal documentation. Providers/members should state “Need to Change Provider, COVID-19” in the request.

 

  • We will temporarily waive hearing screen and well-child requirements for therapy approvals for services that start during the COVID-19 State of Disaster Declaration or for extension requests that are requested during this time.

 

How this impacts providers:

  • This means a claim for out-of-network (OON) PCP office visits (see the above listed provider types) will pay during the COVID-19 Disaster Declaration.

 

  • Certain authorizations as stated above will be waived, relaxed or granted automatic extension.

 

  • In cases where authorization extensions are granted Provider should expect to receive a notice of extension

 

  • Certain supportive diagnostics and testing will be waived as stated above.

 

Next steps for providers:

  • If your request involves a “change of provider,” you must ensure your request includes the following message “Need to Change Provider, COVID-19.” TCHP staff will contact you if further information is needed to process the change request.

 

If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.
For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.

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