Monthly Archives - April 2020

Provider Alert! Approved in-office lab list

table, th, td { border: 1px solid black; } Call to action: Texas Children’s Health Plan (TCHP) utilizes Quest Diagnostics as our exclusive reference lab provider. This alert is to serve as a reminder of the specific labs on our pre-approved list that may be run in a network provider’s office. How this impacts providers: Providers may perform specific lab tests in their office and receive reimbursement from TCHP. All other lab tests must be referred to Quest Diagnostics or State [...]

World Immunization Week

The Centers for Disease Control recognizes the last week of April as World Immunization Week. World Immunization Week promotes the use of vaccinations to protect people of all ages against disease. According to the World Health Organization, immunizations prevent millions of deaths from diseases like diphtheria, influenza, pertussis (whooping cough), and others. Vaccinations work along with our body’s natural defenses to keep us and those around us from getting sick. Vaccinations have significantly decreased the mortality rate or deaths and [...]

Provider Alert!

Provider Alert! VDP Formulary Updates – Update 3

Attention: All Providers and Pharmacies Effective Date: April 21, 2020 Call to action: VDP temporarily revised the preferred drug list to address reported possible drug shortages. A new claims processing edit has also been added to prevent overutilization of antimalarial drugs. Expanded NDCs: The non-preferred status of certain generic formulation NDCs were temporarily removed. The change allows pharmacies to dispense these drugs without requiring a non-preferred prior authorization, and provide continued access to necessary medication. The full list of NDCs can be [...]

Provider Alert!

Provider Alert! Issues with EpiPen, Epi-Pen Jrs, and related generic products

Attention: All Providers and Pharmacies Effective Date: April 21, 2020 Call to action: The FDA is alerting stakeholders that EpiPen 0.3mg and EpiPen Jr 0.15mg auto-injectors, and authorized generic versions, may potentially have delayed or inappropriate injecting. Reasons for failure include: Device failure from spontaneous activation caused by using sideways force to remove the blue safety release Device failure from inadvertent or spontaneous activation due to a raised blue safety release Difficulty removing the device from carrier tube User error may also delay or prevent [...]

Provider Alert!

Provider Alert! Synagis (palivizumab) removed from Texas Medicaid formulary

Attention: All Providers and Pharmacies Effective Date: April 14, 2020 Call to action: The 2019-2020 respiratory syncytial virus (RSV) season ended April 14 for all counties in Texas. Synagis (palivizumab) has been removed from the Texas Medicaid formulary as of April 14. How this impacts providers: Synagis is unproven for prophylaxis outside of the RSV season. Providers wishing to prescribe Synagis during this time must submit a medical necessity request. Next steps for providers: Providers should continue to follow American Academy of Pediatrics [...]

Vaping Severe Health Risk Awareness and Smoking Cessation Benefits

Call to action: This notice is regarding the risk of severe lung disease among individuals who vape. Providers are reminded that screening and information on smoking cessation should be included as part of any routine patient visit. Effective April 1, 2020, The Center for Disease Control (CDC) is implementing a new diagnosis code, U070 for reporting vaping-related disorders as a benefit of Texas Medicaid.  In addition to the services and support available through CHIP and Medicaid Texas Children’s Health [...]

Provider Alert! Association for Community Affiliated Plans (ACAP) webinar on small business relief

Attention: All Providers Effective: April 15, 2020 Providers should monitor the Texas Children’s Health Plan (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. Call to action: TCHP would like to extend an invitation to our network providers to attend a webinar on COVID-19 small business relief on Tuesday, April 28, 2020 at 2:00PM CST. The [...]

April is National Autism Awareness Month

Autism spectrum disorder (ASD) is a developmental disability that can cause significant social, communication and behavioral challenges. Individuals with autism have difficulty interacting with others: building relationships, using language, regulating their emotions, and understanding others’ points of view. The reported prevalence of ASD has been higher in recent years, and this trend is consistent across data sources. Statistics: About 1 in 54 children were identified with autism spectrum disorder among a 2016 sample of 8 year olds from 11 US communities [...]

April is Sexually Transmitted Disease (STD) Awareness month

April is Sexually Transmitted Disease (STD) Awareness month. Cases of sexually transmitted diseases continue to increase in the U.S. The CDC’s new estimates show that there are about 20 million new infections in the United States each year, costing the American health care system nearly $16 billion in direct medical costs ( Because many cases of STDs go undiagnosed—and some common viral infections, such as human papillomavirus (HPV) and genital herpes, are not reported to the CDC at all—the [...]

Provider Alert!

Provider Alert! Second Quarter National Correct Coding Initiative updates

Call to action: Texas Children’s Health Plan (TCHP) supports the National Correct Coding Initiative (NCCI) updates that are implemented for claims processing by TMHP for Texas Medicaid. How this impacts providers: For Health and Behavior Assessment and Intervention (HBAI), codes 96170 and 96171 will no longer be reimbursed after April 1, 2020. Procedure codes 96167 and 96168 will be the only codes for HBAI, which include the member’s family,  that may be reimbursed when the family member directly participates in [...]