Monthly Archives - December 2020

Provider Alert!

Provider Alert! Addition of Bamlanivimab and Casirivimab/Imdevimab as a Texas Medicaid Benefit and for FDA Emergency Use Authorization

Attention: All Providers       Effective Date: December 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: Texas Children’s Health Plan would like to inform network providers that Texas Medicaid has added two medications, bamlanivimab and casirivimab/imdevimab, as outpatient benefits in response to the COVID-19 Emergency [...]

Provider Alert!

Provider Alert! Healthy Texas Women Program Launches Enhanced Postpartum Care Services

Attention: Chemical dependency treatment facilities, opioid treatment programs, licensed professional counselors, licensed clinical social workers, psychologists and psychology groups, psychiatrists, and cardiologists Effective Date: December 29, 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 ensure [...]

Provider Alert!

Provider Alert! Update to Kalydeco Clinical Prior Authorization Guidelines

Attention: Pulmonologists Effective Date: December 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 would like to inform network providers that effective December 28, 2020 Texas Medicaid will update the Kalydeco (ivacaftor) clinical prior authorization criteria. The changes reflect [...]

Provider Alert! COVID-19 Vaccine Administration Information for all Pharmaceuticals

table { border-collapse: collapse; }tr,td { border: solid thin; } Attention: All Providers        Subject: COVID-19 Vaccine Administration Information for all Pharmaceuticals Effective Date: December 11, 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 [...]

Provider Alert!

Provider Alert! Prior Authorization Requirements Guide

table { border-collapse: collapse; }tr,td { border: solid thin; } Attention: All Providers Effective Date: March 8, 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 [...]

Provider Alert!

Provider Alert! Electronic Visit Verification (EVV) Cures Act Implementation January 1st 2021

Attention: Financial Management Services Agencies (FMSAs) Effective Date: 1/1/2021 Call to action: This serves as a final reminder that beginning January 1, 2021 all service visits for an EVV-required service must be captured in the EVV system. Federal law does not allow any further delays to implement the Cures Act EVV requirement for Medicaid personal care services. How this impacts providers: By Dec. 31, 2020: Complete Required Training Program providers, FMSAs, and CDS employers must complete the following EVV training requirements: EVV System Training before using [...]

Provider Alert! New Value Point of Origin for Admission of Visit Code “G,” In Use Beginning July 1, 2020 due to the COVID-19

table { border-collapse: collapse; }tr,td { border: solid thin; } 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 providers that effective July 1, 2020, a new value Point of [...]

Provider Alert!

Provider Alert! Updated Vision Benefit Codes

Attention: Optometrists and ophthalmologists Effective Date: March 9, 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 updated benefit codes for vision services. These services are categorized as either a routine [...]

Provider Alert!

Provider Alert! Annual Utilization Management Notice to All Providers

Attention: All Providers 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.  Affirmative Statement about Incentives As a reminder, Texas Children’s Health Plan (TCHP) Utilization Management (UM) decision-making is based on our Policies, Procedures, and Guidelines. They are based only on appropriateness of care and service and the [...]

Provider Alert!

Provider Alert! Synagis Administration as a Home Health Service

Attention: All Providers Effective Date: November 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 Health and Human Services Commission (HHSC) to provide expanded access to Synagis. Synagis may now be provided with home health [...]