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 not required to appeal the claims unless they are denied for other reasons after the claims reprocessing is complete.

Providers should direct questions to their assigned Provider Relations Liaison or send an email inquiry to the Provider Relations Department at providerrelations@texaschildrens.org.

Call to action: TCHP would like to remind providers of the variety of Healthcare Effectiveness and Data Information Set (HEDIS®) toolkits available on our Provider Resource page with helpful information regarding the measure requirements, standards and codes to use that are acceptable for HEDIS® reporting.

TCHP is excited to announce the addition of Behavioral Health measures to our HEDIS Toolkit. As you know, Behavioral Health applies to all providers on the member’s/patient’s Care Team. We highly encourage all Provider’s, not just Behavioral Health Practitioners, to utilize these tools as you continue to provide excellent care to your patients.

The toolkits are available here: https://www.texaschildrenshealthplan.org/for-providers/provider-resources/hedis-toolkit

How this impacts providers: The goal of the toolkits is to help providers maintain high quality care and meet HEDIS® measures. The toolkits are specifically prepared with guidance for coding the appointment types, medications, and qualifying labs. Toolkits are available on the following measures:

• Maternal Health: Prenatal and Postpartum Care
• Well-Child Visits
• Kidney Health Evaluation for Patients with Diabetes (KED)
• Immunizations for Adolescents
• Weight Assessment and Counseling for Nutrition and Physical Activity (Children & Adolescents)
• HEDIS® Quick Reference ADD – Follow-Up Care for Children Prescribed ADHD Medication
• HEDIS® Quick Reference Antidepressant Medication Management
• HEDIS® Quick Reference Metabolic Monitoring for Children and Adolescents on Antipsychotics
• Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics

Next steps for providers: Another HEDIS® resource providers have access to is the Inovalon HEDIS® Metric Tool. Inovalon allows providers to use performance and patient data so that they can independently manage their patient population, as well as improve the quality of disease management throughout their Member panel. Inovlaon is available from the provider portal. Registration is required for access. Providers that do not currently have access should take advantage of this resource and register so they can better manage their measures.

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.