Provider Alert! Utilization Management COVID-19 Procedure Updatetcph
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 the Utilization Management (UM) COVID-19 Procedure.
The updates effective December 1, 2020 are as follows:
- Change of provider letter is required for a service provider change
- For missing signatures, in plan of care, etc. providers MUST state “missing signatures, COVID-19” in the request
- Documentation of an office visit note for the acute injury or acute exacerbation of the medical condition will be required for authorization of acute therapy services (ST, OT, PT)
- TCHP may accept prior authorization requests submitted within 7 calendar days of the requested service start date and the request will not be considered retrospective
The updates for March 1, 2021 are as follows:
- Yearly treating physician office visit is required, for private duty nursing prior authorization approval
- Documentation of current Texas Health Steps Checkup is required for speech, physical and occupational therapy prior authorizations
As a reminder, hearing screening requirements remain waived for speech therapy.
How this impacts providers: Providers should follow the updates made to the utilization management procedure and submit the requests for coverage timely to ensure payment.
Next steps for providers: Update their office staff on the new utilization management procedure updates.
If you have any questions, please email Provider Network Management at: firstname.lastname@example.org.