Provider Alert! COVID-19 Disaster Declaration – Texas Children’s Health Plan Operational Adjustments

Provider Alert! COVID-19 Disaster Declaration – Texas Children’s Health Plan Operational Adjustments

Attention: All Providers
Effective Date: March 13, 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.

 

Reporting adjustments to normal provider business operations

Texas Children’s Health Plan has developed a provider notification survey which is posted on the Provider portal www.texaschildrenshealthplan.org/for-providers and the website. This survey allows providers to self-report to TCHP any changes in business operations, any service hour restrictions, and/or closures. The TCHP provider relations staff are performing telephonic outreach to all PCP’s, high volume specialties and LTSS providers to advise and educate on this process as well as help to complete the surveys if needed.

 

Claim Filing Deadline Temporarily Extended

Due to the demands on our healthcare providers in light of the novel COVID-19 event, TCHP is extending the timely filing deadline by 30 days.  TCHP is offering a 30-day extension to submit clean cleans for:

  • Claims which would exceed the standard 95-day timely filing limit starting on 03/13/2020 through 04/13/2020 or upon expiration of the COVID-19 disaster declaration period, whichever is later.
  • Claims with dates of service 03/13/2020 through 04/13/2020 or upon expiration of the COVID-19 disaster declaration period whichever is later.

 

Pharmacy Update

Due to the COVID-19 disaster declaration,

 

  • TCHP is reviewing “out of state” pharmacy override requests on a case-by-case basis. TCHP is waiting on guidance from the state to allow pharmacies to fulfill prescriptions.
  • TCHP is NOT modifying its prior authorization edits or process at this time. Urgent renewal requests for expired prior authorization requests will be expedited and reviewed on a case- by-case basis.
  • Pharmacies can provide 72-hour fills if providers are unable to respond to the request in a timely manner.
  • TCHP is currently NOT providing 90-day fill blanket overrides or waiver of other prescription fill edits. Exception requests are reviewed on a case-by-case basis.
  • Exceptions are provided for early medication requests – the “refill too soon” override will be in effect for up to 30 days.
  • Pharmacies can provide up to 30-day fills of maintenance medications if a member’s existing prescription expires.
  • TCHP is waiting on guidance from HHSC – VDP program officials for additional edit overrides that may be approved in the future due to the COVID-19 event. TCHP will notify providers as soon as possible of those updates or changes affecting the Pharmacy benefit administration for our programs.

 

How this impacts providers:

 

  • If your practice or business experiences a need to adjust your normal business operations, inform TCHP immediately. Our business operations reporting survey form can be found at texaschildrenshealthplan.org/for-providers or contact your TCHP Provider Relations Representative for assistance.
  • If your practice or business is impacted by COVID-19 you may need extra time to file a claim, TCHP is extending it timely clean claim filing.
  • Claims which would exceed the standard 95-day timely filing limit on or after 03/13/2020 through 04/13/202 or upon expiration of the COVID-19 disaster declaration period whichever is later.
  • Claims with dates of service 03/13/2020 through 04/13/2020 or upon expiration of the COVID-19 disaster declaration period whichever is later.
  • The coordination of Pharmacy Services has limited adjustments to normal program standards (see updates above).

 

Next steps for providers:

 

  • TCHP-affiliated providers should monitor the TCHP Provider Portal regularly for alerts and updates associated to the COVID-19 event.
  • If your practice or business experiences a need to adjust from your normal business operations, inform TCHP immediately. Our reporting survey form can be found at texaschildrenshealthplan.org/for-providers or contact your TCHP Provider Relations Representative who can assist you.

 

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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