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 1, 2022. We have identified the root cause and are actively working to ensure the appropriate fee schedule for each PDN provider is applied for payment.

How this impacts providers: Any PDN provider impacted by this error will have their claims reprocessed once the appropriate fee schedules are verified in our system. This is the top priority for TCHP. We have all necessary resources dedicated to this issue and are working as quickly as possible to address and correct this issue. Remediation efforts include updating our systems to ensure all future claims received are accurately paid, then reprocessing any retroactively impacted claims to pay with interest, as applicable. At this time, we anticipate having all remediation efforts associated with the PDN rate issue for all impacted home health providers completed by September 18^th 2022.

Next steps for providers: We appreciate your patience and continued partnership. If you have any questions or concerns related to this issue or the remediation timeline, please contact your Provider Relations Liaison. We will continue to provide updates as they become available.

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