Monthly Archives - May 2020

Provider Alert!

Provider Alert! Adakveo Update

Attention: Hematologists Effective Date: May 26, 2020 Call to action: Adakveo, Injection, crizanlizumab - clinician administered drug HCPCS code C9053 is an at risk drug. Currently, there is no prior authorization required; however, beginning May 26, 2020 authorization guidelines will be in place. The required criteria to receive Adakveo include: HbSS (sickle cell) diagnosis Patients over the age of 16 years-old Patients that have experienced more than two vaso-occlusive crisis (VOC) events in the past 12-months How this impacts providers: Prescribers should adhere to the guidelines and [...]

Provider Alert!

Provider Alert! Housing Choice Plan Survey

Attention: All Providers Effective Date: Survey open May 15, 2020 until June 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: The Health and Human Services Commission’s (HHSC) Behavioral Health Advisory Committee has approved the development of a Housing Choice Plan for individuals [...]

National Blood Pressure Awareness Month

Blood pressure is the pressure of blood pushing against the walls of your arteries. Hypertension, also known as high blood pressure, is the force of your blood against the walls of your blood vessels. Hypertension increases the risk for heart disease and stroke. Sponsored by the Centers for Disease Control and Prevention (CDC) and recognized by the National Heart, Lung and Blood Institute (NHLBI), National High Blood Pressure Awareness Month raises awareness about the impact of hypertension (healthinsight.org). High Blood [...]

Provider Alert!

Provider Alert! Secretion and Mucous Clearance Devices

Attention: Pulmonologists and DME providers Effective Date: June 3, 2020 Call to action: Secretion and mucous clearance devices will require prior authorization except for percussion cups. Here is the link to the Prior Authorization Form: http://www.tmhp.com/Provider_Forms/PA_Forms/F00145_Prior_Auth_for_Secretion_and_Mucus_Clearance_Devices_Initial.pdf Information on coding for devices: Device Code Intrapulmonary Percussive Ventilation (IPV)* E0481. TCHP will no longer accept E1399. This is not a current benefit of Texas Medicaid and will be reviewed by the TCHP Medical Director on a case- by-case basis. Percussion cup E1399 purchase only. Does not require a Prior Authorization. Electrical percussors E0480 [...]

Register for the June CME: COVID-19 Looking to the Future

COVID-19 – Looking to the Future: Where are we now and where do we go from here? Presented by Texas Children’s Health Plan Wednesday, June 17, 2020 – 5:30-7:30 p.m. – Live stream via WebEx Topics covered will include: Progress toward a COVID-19 Vaccine Fall 2020: Managing COVID-19 and the Flu in a Pediatrics Practice Telemedicine: How to Keep the Momentum Going Q&A with Dr. Lisa Hollier The CME will be presented by: Dr. Mark Ward Director, Pediatric Residency Program Baylor College of Medicine/Texas Children’s Hospital Dr. Robert Ball Medical Director, eHealth Texas [...]

Provider Alert!

Provider Alert! Continuing Education Credit: Immunizations

Attention: Primary Care Providers and Pharmacists Effective Date: May 18, 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: Primary Care Providers as well as other interested healthcare professionals are encouraged to participate in this online course provided by the Health and Human Services Commission [...]

Provider Alert!

Provider Alert! Reminder: Authorization Guidelines for a hospitalized member – post discharge services and supplies

Attention: All Providers Effective Date: May 20, 2020 Call to action: Texas Children’s Health Plan (TCHP) is aligned with the Uniform Managed Care Contract (UMCC) Guideline for members with an authorization request during hospitalization (reference: 8.1.8 Utilization Management). The guideline states that TCHP must issue coverage determinations for a member who is hospitalized at the time of the request, within one Business Day of receiving the request for services or equipment that will be necessary for the care of the Member [...]

Provider Alert!

Provider Alert! Continuing Education credit: Transition Services for Children and Youth with Special Health Care Needs

Attention Primary Care Providers Effective Date: May 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: Primary Care Providers that care for members with special health-care needs are encouraged to participate in this online course provided by the Health and Human Services Commission [...]

Provider Alert! Families First Coronavirus Response Act Information

Attention: Financial Management Services Agencies and Consumer Directed Services employers Effective Date: This rule is in effect April 2, 2020 to December 31, 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: The United States Department of Labor (DOL) issued a temporary rule [...]

Provider Alert!

Provider Alert! Live EVV Training Webinars in June

Attention: Existing Electronic Visit Verification (EVV) Users Effective Date: June 16-June 17 Call to action: In June, the Health and Human Services Commission (HHSC) and Texas Medicaid & Healthcare Partnership (TMHP) will hold live Electronic Visit Verification (EVV) policy and EVV Portal training webinars for program providers currently required to use EVV. How this impacts providers: Program providers must complete EVV Portal training and EVV policy training annually. See the following link for more information: https://hhs.texas.gov/sites/default/files/documents/doing-business-with-hhs/providers/long-term-care/evv/evv-required-training-checklist.pdf Next steps for providers: To meet the annual training [...]