Monthly Archives - November 2020

Provider Alert! Utilization Management COVID-19 Procedure Update

Attention: Therapy, LTSS, Private Duty Nursing, and DME Service Providers        Effective Dates: December 1, 2020 and March 1, 2021 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 network providers of the following updates made to [...]

Provider Alert!

Provider Alert! Benefit reminder and Prior Authorization Update for Spravato

Attention: Behavioral health Providers Effective Date: January 1, 2021 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 Health and Human Services Commission (HHSC) on the revised prior authorization criteria for Spravato (Esketamine). Effective January 1, 2021, [...]

Provider Alert!

Provider Alert! Medically Dependent Children Program Waiver (MDCP) Eligibility Process and Peer-to-Peer Review

Attention: Primary Care Providers and Sub Specialists  Effective Date: December 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: Per Texas Health and Human Services Commission (HHSC) contract changes effective December 1, 2020, Texas Children’s Health Plan (TCHP) would like to inform network [...]

OB Provider Incentive Program Updates

Texas Children’s Health Plan offers an OB Provider Incentive Program to reward your OB provider group for providing quality care to our members during their pregnancy, from early prenatal care to delivery and timely postpartum care. Learn how the program works: 2021 OB Provider Incentive Program Brochure 2022 OB Provider Incentive Program Brochure

Provider Alert!

Provider Alert! Zolgensma Update – new TMPPM criteria pending publication

mark { background-color: yellow; color: black; } Attention: Neurologists and SMA specialists Effective Date: December 1, 2020  Call to action:  Prescribers should be aware of an update to prior authorization criteria for Zolgensma (onasemnogene abeparvovec) drug HCPCS code J3399. Zolgensma is indicated for treatment of pediatric patients (<2 years of age) with Spinal Muscular Atrophy (SMA). Effective December 1, diagnosis of Type I SMA (diagnosis code G120) will require three or less copies of SMN-2. Previous criteria required two or fewer copies. All other [...]

Provider Alert!

Provider Alert! Updates to Prior Authorization Requirements for Genetic Testing, Wheelchair accessory, and Personal Care Services

Attention: All providers Effective Date: March 1, 2021 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 network providers of services that require a prior authorization effective March 1, 2021. Genetic Testing Codes: 81202 APC (adenomatous polyposis coli) [...]

Provider Alert!

Provider Alert! Updates to Prior Authorization Requirements for CADs, electronic bone growth stimulators, home telemonitoring, and hospital beds

Attention: All providers Effective Date: February 1, 2021 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 network providers of Prior Authorization updates. Clinician Administered Drugs (CAD) that require a prior authorization effective February 1, 2021: 90378, [...]

Provider Alert!

Provider Alert! HHSC Texas Behavioral Health Services Survey

Attention: Behavioral Health Providers    Effective Date: Survey is available until November 21, 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 network Behavioral Health providers of a recent survey the Health and Human Services Commission [...]

Provider Alert!

Provider Alert! Benefits for Telemedicine Services and Telehealth Services to Change for Texas Medicaid December 1, 2020

Attention: FQHCs and  School-based Clinics Effective Date: For dates of service on or after December 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 changes to telemedicine (physician-delivered) services and telehealth (non-physician delivered) services include [...]

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Provider Alert! Peer Specialist Services Became a Benefit of Texas Medicaid January 1, 2019

Attention: Behavioral Health Providers Effective Date: October 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: Texas Children’s Health Plan (TCHP) would like to inform providers that Code H0038 is a benefit of Texas Medicaid for members 21 years of age and older [...]