Provider Alert! New Edit Implemented by Claims Processor, Change HealthCare

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 that beginning February 1, 2021, Change Health Care (CHC) will require the following information on all UB04 (837I) claims:

• Attending provider name- the individual who would normally be expected to certify and re-certify the medical necessity of the number of services rendered or who has primary responsibility for the patient’s medical care and treatment.
• National Provider Identifier (NPI) Number- NPI must be submitted unless the provider has an API assigned, which will be reported in Loop 2310A.
• Taxonomy code as per Texas Medicaid’s requirement-it is critical that the taxonomy code selected as the primary or secondary taxonomy code during a provider’s enrollment with Texas Medicaid and Healthcare Partnership (TMHP) is included on all electronic transactions. The appropriate information as indicated on the provider enrollment letter.

As a reminder, claims must also include the following information:

• The most appropriate ICD-10-CM diagnosis code that represents the purpose for the service.
• The most appropriate Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) procedure code that represents the service provided.

Sources: 2019 TMHP News – 10-18-2019 Attending Outpatient

TMHP Companion Guide: TMHP 837I-ACUTE-CARE-COMPANION-GUIDE-5010

Texas Medicaid Provider Procedure Manual: https://www.tmhp.com/sites/default/files/file-library/resources/provider-manuals/tmppm/archives/2020-12-TMPPM.pdf

Section 2.4.1

Section 6.2.1

Sections 6.4.2.5

How this impacts providers: Providers should verify that their claims are configured to be submitted with all of the required fields by the February 1, 2021 effective date. Claims missing some or all of the required information on or after February 1, 2021 may be rejected.

Next steps for providers: Provider should share this communication with their billing staff.

If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.

For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.