Monthly Archives - May 2021

Provider Alert!

Provider Alert! Cystic Fibrosis and Spinal Muscular Atrophy Screening Authorization No Longer Required

Date: May 27, 2021 Attention: Obstetric Care Providers Effective Date: June 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 June 1, 2021; a prior authorization is no longer required for [...]

Provider Alert!

Provider Alert! New Transportation Vendor for TCHP Members beginning June 1st

Date: May 20, 2021 Attention: All Providers Effective Date: June 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) will be changing transportation vendors for both Non-Emergent Medical Transportation (NEMT) and Value Added Services (VAS) rides beginning June 1, [...]

Provider Alert!

Provider Alert! Clinical Prior Authorization Updates for Enzymes

Date: May 20, 2021 Attention: Geneticists, Hematologists, and Oncologists Effective Date: June 30, 2021 Call to action: Effective June 30, 2021, the Texas Health and Human Services Commission (HHSC) will update the enzymes prior authorization criteria to reflect recent FDA-approved administration changes. This impacts the following agents: Adagen (pegademase bovine), Ceprotin (protein C concentrate), Fabrazyme (agalsidase beta), and Revcovi (elapegademase). Adagen (J2504 procedure code) has been discontinued by the manufacturer. Ceprotin 400-600 units vial is no longer available through retail pharmacy benefits. The Ceprotin 400-600 [...]

Provider Alert! Adolescent Eligibility for Pfizer-BioNTech COVID-19 Vaccine

Date: May 20, 2021 Attention: All Pediatric and Family Medicine Providers Effective Date: May 12, 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 make network providers aware of new guidance approved by the Food and Drug [...]

Provider Alert!

Provider Alert! After hours Codes Reminder

Date: May 14, 2021 Attention: PCPs and Urgent Care Facilities 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 remind providers of Medicaid After-Hours Procedure Codes that do not require prior authorization. How this impacts providers: Below are the Medicaid Payable After-Hours [...]

Provider Alert!

Provider Alert! Child Psychiatry Access Network, free consultations for PCP’s caring for members with behavioral health concerns

Date: May 12, 2021 Attention: Primary Care 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. Call to action: Texas Children’s Health Plan (TCHP) collaborates with the Child Psychiatry Access Network (CPAN) who offers free consultations for Primary Care Providers (PCPs) who see children within the state [...]

Provider Alert!

Provider Alert! Developmental and Mental Health Screening Tools Added for the THSteps Preventive Care Medical Checkups

Date: May 11, 2021 Attention: Pediatric Providers Effective Date: June 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 would like to inform network providers of two new developmental and mental health-screening tools that will be added to the Texas [...]

Provider Alert! COVID-19 Pediatric Provider Enrollment

  Date: May 7, 2021 Attention: All Pediatric 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. Call to action: Texas Children’s Health Plan would like to inform network providers that the Texas Department of State Health Services (DSHS) Immunization Unit is encouraging all pediatric providers to enroll [...]

Provider Alert! Texas Children’s Health Plan to host special live CME event

Recognizing the Need for Referrals for Common Diseases Identify the most common issues with cardiac, infectious and respiratory diseases and recognize when specialist referrals are necessary. This is a free, online CME course for contracted providers of the health plan provided by Texas Children’s Hospital. Thursday, May 27, 2021 – 5:30 p.m. – 7:30 p.m. – Live stream via WebEx CME Objectives: Identify the most common cardiac issues encountered in a General Pediatric Clinic and recognize when Cardiology referrals are necessary Identify common infectious [...]