Monthly Archives - September 2022

Provider Alert!
26Sep

Provider Alert! Drug Regimen Optimization Edit Removed After September 12

Date: September 20, 2022 Attention: All Providers Effective Date: September 12, 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. Call to action: Beginning September 12, 2022, Texas Children's Health Plan (TCHP) will remove the Drug Regimen Optimization prior authorization for all drugs except ADHD drugs. The Health...

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Provider Alert!
26Sep

Provider Alert! Prior Authorization Criteria Update for Adakveo

Date: September 20, 2022 Attention: All Providers Effective Date: December 1, 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. Call to action: Effective December 1, 2022, the Health and Human Services Commission (HHSC) will update prior authorization criteria for Adakveo (procedure code J0791). HHSC updated the prior...

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Provider Alert!
26Sep

Provider Alert! Prior Authorization Criteria Update for Zolgensma

Date: September 20, 2022 Attention: All Providers Effective Date: November 11, 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. Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective November 1, 2022, the Health and Human Services Commission (HHSC) will update the...

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Provider Alert!
26Sep

Provider Alert! Temporary Change in PDL Status for Antihypertensives, Sympatholytics Drug Class

Date: September 26, 2022 Attention: All Providers Effective Date: September 26, 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: The Health and Human Services Commission (HHSC) is aware of a drug shortage for Catapres-TTS patches in the Antihypertensives, Sympatholytics drug class due to...

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Provider Alert!
26Sep

Provider Alert! Age and Diagnosis Restriction Updates for Cabenuva, Oncaspar, Zulresso

Date: September 22, 2022 Attention: All Providers Effective Date: October 1, 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. Call to action: Texas Children’s Health Plan’s (TCHP) would like to inform providers that effective October 1, 2022, the age and diagnosis restrictions for Cabenuva (J0741), Zulresso (J1632),...

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Provider Alert!
26Sep

Provider Alert! Provider Information and Resources on CHIRP, DPP BHS, RAPPS and TIPPS

Date: September 23, 2022 Attention: All Providers Subject: Provider Information and Resources on CHIRP, DPP BHS, RAPPS and TIPPS 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. Call to action: Below is information from the Health and Human Services Commission (HHSC) regarding the Comprehensive Hospital Increase Reimbursement Program...

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Provider Alert!
23Sep

Provider Alert! ZZ Taxonomy Qualifier Requirement and Billing Taxonomy Reminder

Date: September 23, 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. Call to action: Texas Children’s Health Plan would like to provide guidance for the ZZ taxonomy qualifier and the billing taxonomy claims requirements. How this impacts providers: ZZ Taxonomy Qualifier: This communication is to notify providers...

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Provider Alert!
22Sep

Provider Alert! Clinical Practice Guidelines Resource Reminder

Date: September 21, 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. Call to action: The purpose of this communication is to remind providers about their access to Texas Children’s Health Plan’s (TCHP) Clinical Practice Guidelines and to inform of updated guideline content. How...

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Provider Alert!
15Sep

Provider Alert! Medicaid Preferred Drug List and Formulary Changes

Date: September 14, 2022 Attention: All Providers Effective Date: July 28, 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. Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that the Texas Vendor Drug Program (VDP) implemented changes to the state Medicaid drug formulary,...

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Provider Alert!
13Sep

Provider Alert! Private Duty Nursing Fee Schedule Review

Date: September 13, 2022 Attention: Private Duty Nursing 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) is aware that some providers are seeing reduced payments for Private Duty Nursing (PDN) claims with dates of service on or after August...

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