Monthly Archives - June 2020

Provider Alert! Service Planning for Pregnant Women during COVID-19

Attention: OB/GYN Providers Effective Date: June 26, 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. The content in this message will remain in effect throughout the COVID-19 Disaster Declaration period as announced by the office of the Texas Governor, Greg Abbott.  COVID-19 Utilization Management Procedure and [...]

Provider Alert! MDCP Interest List Releases postponed through COVID-19 Disaster Declaration Period

Attention: STAR Kids Providers Effective Date: June 26, 2020 The content in this message will remain in effect throughout the COVID-19 Disaster Declaration period as announced by the office of the Texas Governor, Greg Abbott. COVID-19 Utilization Management Procedure and provider alerts can be found here: http://www.thecheckup.org/provider-alerts/ 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 [...]

Provider Alert! COVID-19/Pharmacy Revised Update from June 8, 2020

Attention: All Providers and Pharmacies Effective Date: June 24, 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 Food and Drug Administration (FDA) has removed the emergency use authorization of hydroxychloroquine (HCQ) and chloroquine due to controlled studies showing no evidence of benefit for [...]

Provider Alert!

Provider Alert! Prosthetics Codes Prior Authorization Requirements

Attention: Prosthetics, DME providers, orthopedists, podiatrists, PCPs Effective Date: June 3, 2020 Call to action: Texas Children’s Health Plan (TCHP) aligns with Texas Medicaid Provider Procedures Manual (TMPPM) and requires prior authorization for prosthetics procedures codes. How this impacts providers: Provider offices should utilize the Standard Prior Authorization Form for prosthetics. References: TCHP Prior Authorization Requirements TCHP Prosthetics Guidelines Next steps for providers: Providers should reference the prosthetic procedure codes according to TMPPM section 2.2.19.2 Prior Authorization and Documentation Requirements. If you have any questions, please email Provider [...]

Provider Alert!

Provider Alert! Prior Authorization guidelines for Manual Wheelchair Accessory Code E2227

Attention: All Providers Effective Date: June 23, 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: Texas Children’s Health Plan (TCHP) aligns with the Texas Medicaid Provider Procedures Manual (TMPPM) regarding the authorization requirements for Code E2227, manual wheelchair accessory, and gear reduction drive [...]

Provider Alert!

Provider Alert! Update: Prior Authorization Criteria for Brexanolone (Zulresso)

Attention: : Behavioral Health and Obstetric care providers Effective Date:  July 1, 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: Texas Children’s Health Plan (TCHP) would like to inform you of a new benefit for members and an update to the prior authorization criteria for [...]

Provider Alert!

Provider Alert! Speech generating software authorization reminder

Attention: Speech Therapists Effective Date: June 23, 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: Texas Children’s Health Plan (TCHP) would like to inform you that we align with Texas Medicaid Provider Procedure Manual (TMPPM) regarding the guidelines for Code E2511, Speech generating software program, [...]

Provider Alert!

Provider Alert! Benralizumab, Mepolizumab, and Omalizumab Benefits in the Home Setting

Attention: Pulmonologists, Allergists, and DME Providers Effective Date: For dates of service on or after June 1, 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: Texas Children’s Health Plan (TCHP) aligns with the new guidelines from the Health and Human Services Commission (HHSC) for dates [...]

Provider Alert!

Provider Alert! Authorization update for orthoses devices and related services

Attention: DME providers, orthopedists, podiatrists, PCPs Effective Date: September 5, 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: Texas Children’s Health Plan (TCHP) would like to inform providers of the authorization requirements for custom fitted orthoses devices.  Certain prefabricated orthoses devices for acute [...]

Provider Alert!

Provider Alert! Home Health DME and Supplies Exceptional Circumstances Provision for Medicaid Members 21 years of age and older

Attention: DME Providers Effectvie Date: June 1, 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: Texas Children’s Health Plan aligns with the Texas Medicaid and Healthcare Partnership (TMHP) new guidance for Durable Medical equipment (DME) and supplies under exceptional circumstances. Effective June 1, [...]