Monthly Archives - August 2020

Provider Alert!

Provider Alert! COVID-19 Procedure Codes S8301 and 99001 Information

table { border-collapse: collapse; }tr,td { border: solid thin; } Attention: All Providers Effective Date: Dates of service on or after April 1, 2020 Updated September 10, 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 [...]

Provider Alert!

Provider Alert! Updates to the Provider Incentive Program

table { border-collapse: collapse; } tr,td { border: solid thin; } Attention: Primary Care Providers Effective Date: August 2020 Texas Children’s Health Plan would like to thank you for the dedication and care you continually provide to our valued members. We appreciate all your effort in improving the quality of care our members receive every day. Our HEDIS metrics are just one way we see that outcome, and it is reflected in our provider incentive program (PIP) [...]

Provider Alert!

Provider Alert! Outpatient Medical Drug Billing Requirements Reminder

Attention: All Providers Effective Date: September 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: Effective September 1, 2020, TCHP will reject outpatient medical drug claims for clinician administered drugs (CADs) without the proper national drug code (NDC), healthcare common procedure coding system (HCPCS), and billing unit [...]

Provider Alert!

Provider Alert! Single-Dose Vial Unused Portion Reimbursement Policy for Clinician-Administered Drugs

Attention: All Providers Effective Date: September 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 Texas Medicaid and Healthcare Partnership (TMHP) regarding the reimbursement policy for the unused portion of a single use vial for [...]

Provider Alert!

Provider Alert! Prior Authorization Guideline updates for Private Duty Nursing (PDN) and therapy specialty services

Attention: All Providers Effective Date: July 18, 2020 for PDN and August 11, 2020 for therapy Services 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 inform you of recent updates to the prior authorization requirements and the effective dates. Updates [...]

Provider Alert!

Provider Alert! Uniform Opioid Policy Begins September 1

Attention: All Providers Effective Date: September 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: Effective September 1, 2020, the Vendor Drug Program (VDP) will implement a uniform opioid policy to encourage appropriate use and reduce opioid over-prescribing. The opioid policy does not apply to chronic pain, [...]

Provider Alert!

Reminder: Mandatory PMP verification to prescribe and dispense certain controlled substances

Attention: All Providers Effective Date: August 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: This is a reminder that as of March 1, 2020, pharmacists and prescribers have been required to check the patient’s Prescription Monitoring Program (PMP) history before prescribing or [...]

Is It Anxiety or Does Kevin have COVID 19?

Clinical Vignette: It’s 4 p.m. on a busy Thursday. Kevin and his mother zoom into your office for the third time in six weeks. Today’s chief complaint is stomach pain and mild diarrhea. Kevin is 9 years old and has had some stomach issues in the past. His mother has been reading up on COVID-19 and heard that children more often present with stomach versus respiratory symptoms. The history does not really fit COVID-19 and you are starting to wonder [...]

Provider Alert!

Provider Alert! Generic Albuterol Products Return to Non-Preferred Status for Medicaid Members

Attention: All Providers Effective Date: August 28, 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: Beginning August 28, 2020 the Texas Vendor Drug Program (VDP) will restore non-preferred status to a number of generic albuterol products. VDP temporarily removed nonpreferred status from these [...]

Provider Alert!

Provider Alert! Providers who are leaving the TCHP Participating Provider Network

table { border-collapse: collapse; } tr,td { border: solid thin; } Attention: All Providers Effective Date: State Fiscal QTR 3 & 4 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 and its continued governmental Emergency Declaration. CHANGES TO THE TCHP PARTICIPATING PROVIDER NETWORK The following is a list of [...]