Monthly Archives - March 2022

Provider Alert!
29Mar

Provider Alert! Guidance on Medicaid Coverage of Generators

Date: March 29, 2022 Attention: All Providers Effective date: June 27, 2022 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated with 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. TCHP will apply updates and reprocess impacted claims as soon as possible. However, please allow up to sixty (60) business days for reprocessing. Providers are not required...

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Provider Alert!
25Mar

Provider Alert! Retrospective Review of Paid Claims with Electronic Visit Verification (EVV) Claims Matching

Date: September 10, 2021 Attention: STAR Kids Providers/Personal Care Services & FMSA Providers Effective Date: September 10, 2021 Call to action:  In alignment with HHSC requirements, Texas Children’s Health Plan will begin a review of paid claims that require a matching EVV transaction for dates of service March 21, 2020 – December 31, 2020. Claims that were bypassed under the “EVV007 – Match Not Required” exception were granted 180 days to complete the necessary visit maintenance. This time period has now lapsed. Upon...

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Provider Alert!
23Mar

Provider Alert! Rendering Provider Edit Requirements

Date: March 23, 2022 Attention: All Providers Effective Date: June 21, 2022 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. Regarding system configuration updates, TCHP will apply updates and reprocess impacted claims as soon as possible. However, due to volume, please allow up to sixty (60) business days to...

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Provider Alert!
21Mar

Provider Alert! EVV Required Free Text Reviews Postponed for CDS Option

Date: March 21, 2022 Attention: Financial Management Services Agencies and Consumer Directed Services employers 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. Regarding system configuration updates, TCHP will apply updates and reprocess impacted claims as soon as possible. However, due to volume, please allow up to sixty (60)...

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21Mar

Provider Alert! Update to COVID-19 Testing Billing, Modifier QW

Date: March 21, 2022 Attention: Primary Care Providers Effective Date: January 3, 2022 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. Regarding system configuration updates, TCHP will apply updates and reprocess impacted claims as soon as possible. However, due to volume, please allow up to sixty (60) business days...

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Provider Alert!
21Mar

Provider Alert! HEDIS® Toolkits Provider Resource Reminder

Date: March 15, 2022  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. Regarding system configuration updates, TCHP will apply updates and reprocess impacted claims as soon as possible. However, due to volume, please allow up to sixty (60) business days to complete. Providers are...

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Provider Alert!
17Mar

Provider Alert! HEDIS® Toolkits Provider Resource Reminder

Date: March 17, 2022 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. Regarding system configuration updates, TCHP will apply updates and reprocess impacted claims as soon as possible. However, due to volume, please allow up to sixty (60) business days to complete. Providers are...

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Provider Alert!
10Mar

Provider Alert! Cytokine and CAM Antagonists Criteria Updates Scheduled for April 5

Date: March 10, 2022 Attention: Providers Effective Date: April 5th, 2022 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: On April 5, 2022, HHSC will make the following revisions to various Cytokine and CAM Antagonists clinical prior authorization criteria to ensure alignment with US Food and Drug...

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Provider Alert!
10Mar

Provider Alert! Updates to Phosphate Binder Prior Authorization Criteria Scheduled for April 5

Date: March 10, 2022 Attention: Primary care providers Effective Date: April 05, 2022 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: On April 5, 2022, HHSC will revise the phosphate binder non-preferred prior authorization criteria by transferring specific criteria to the phosphate binders’ clinical prior authorization. This...

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Provider Alert!
10Mar

Provider Alert! Oxbryta Prior Authorization Criteria Updates Scheduled for April 5

Date: March 10, 2022 Attention: Primary care providers Effective Date: April 5, 2022 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:  On April 5, 2022, HHSC will revise the prior authorization criteria in the Sickle Cell Disease Agents clinical prior authorization for Oxbryta (voxelotor) to ensure alignment with...

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