Monthly Archives - April 2023

Provider Alert!
28Apr

Provider Alert! Non-Formulary Requests for Obesity Control Drugs

Date: April 28, 2023 Attention: All Providers Effective Date: March 1, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective March 1, 2023, the Health and Human Services Commission (HHSC) will no longer approve medically necessary non-formulary drug requests for obesity control drugs for individuals 21 years and older. This aligns with the Social Security Act, Section 1905, since coverage of these drugs is not included in the Medicaid State Plan. The drugs excluded from...

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Provider Alert!
28Apr

Provider Alert! New Audit Programs Vendor EXL

Date: April 27, 2023 Attention: All Providers Effective Date: April 26, 2023 Call to action: Texas Children’s Health Plan (TCHP) Controls and Compliance (CC) would like to let providers know that TCHP has contracted with an external auditor, ExlService.com (EXL) to support its upcoming audit efforts. For your awareness, TCHP’s CC is organized within the Office of General Counsel under the Controls and Compliance Department. EXL is currently conducting audits, and will introduce the following new audit programs starting April 26, 2023: High Cost Drug...

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Provider Alert!
27Apr

Provider Alert! UPDATE: Provider Enrollment and Management System (PEMS) Provider Guidance

Date: April 27, 2023 Attention: All Providers NEW Effective Date: June 30, 2023 Important provider notice: As a reminder, the Provider Enrollment and Management System (PEMS) is the required Texas Medicaid & Healthcare Partnership (TMHP) program which is the single tool for provider enrollment, reenrollment, revalidation, and maintenance requests (maintaining and updating provider enrollment record information) for Texas Medicaid. Accordingly, as an MCO, TCHP will contract, credential and pay only those providers who are properly enrolled with TMHP and whose information is received in...

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Provider Alert!
25Apr

Provider Alert! Clinical Criteria Revision for Cibinqo Effective May 31, 2023

Date: April 25, 2023 Attention: All Providers Effective Date: May 31, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective May 31, 2023, the Health and Human Services Commission (HHSC) will expand coverage for Cibinqo to adolescents 12-18 years of age due to a recent U.S. Food and Drug Administration (FDA) approval. Cibinqo belongs to a class of medications called Janus Kinase (JAK) Inhibitors and is indicated for the treatment of adults with refractory moderate-to-severe atopic...

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Provider Alert!
25Apr

Provider Alert! Olumiant Clinical Prior Authorization Revision Effective March 27

Date: April 21, 2023 Attention: All Providers Effective Date: March 27, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective March 27, 2023, the Health and Human Services Commission (HHSC) revised the clinical prior authorization approval criteria for Olumiant, a Janus Kinase (JAK) Inhibitor. Olumiant is prescribed for adults with severe alopecia areata and adults with moderate to severely active rheumatoid arthritis. The prior authorization approval criteria revisions were made to match the information in the...

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Provider Alert!
25Apr

Provider Alert! Lidocaine 5% Patch Added To PDL

Date: April 21, 2023 Attention: All Providers Effective Date: April 3, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective April 3, 2023, the Texas Health and Human Services Commission (HHSC) temporarily removed the non-preferred status from the generic product, Lidocaine 5% patches on the preferred drug list (PDL). The preferred status of the brand name products (NDC 63481-0687-06) will not change to allow for any existing stock available to be utilized. This is in response...

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Provider Alert!
20Apr

Provider Alert! Provider Offices are eligible for Incentive with Completion of Provider Satisfaction Survey

Date: April 19, 2023 Attention: All Providers Launch timeframe: Spring 2023 Call to action: Texas Children’s Health Plan (TCHP) is excited to launch our annual Provider Satisfaction Survey this spring- this time with a new feature. Provider offices that complete the survey will be entered into a gift card drawing*. Winning practices will be contacted at the conclusion of the survey. SPH Analytics will be facilitating the survey during this spring. This way, the individual survey responses remain anonymous. When the time comes, you...

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Provider Alert!
19Apr

Provider Alert! Retracted: Coordination of Benefits for Utilization Management Update

Date: April 19, 2023 Attention: All Providers Call to action:  As you may remember, Texas Children’s Health Plan (TCHP) previously communicated changes to our Coordination of Benefits Procedure on February 15, 2023. After careful consideration and listening to your concerns, the Utilization Management (UM) team has decided to pause on any changes and revert back to the original procedure. A link to the former procedure that is currently being followed is available here. How this impacts providers: Providers that received a rejection letter due...

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18Apr

Provider Alert! COVID-19 Vaccine Counseling Procedure Code G0315 Now a Benefit

Date: April 14, 2023 Attention: All Providers Effective Date: Dates of service on or after December 2, 2021 Call to action: Texas Children Health Plan (TCHP) would like to inform providers that effective for dates of service on or after December 2, 2021, COVID-19 vaccine counseling procedure code G0315 is a benefit of Medicaid for individuals birth through 20 years of age. How this impacts providers: Procedure code G0315 will be limited to once per day for the same provider, as well as three...

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Provider Alert!
18Apr

Provider Alert! Infant Well-Child Visits Reminder

Date: April 18, 2023 Attention: Primary Care Providers Call to action: Texas Children’s Health Plan (TCHP) encourages providers to ensure their infant patients are receiving timely well-child visits and immunizations, in compliance with the Texas Health Steps (THSteps) periodicity schedule. TCHP is committed to ensuring members recognize the importance of preventive care and is working with members to better understand and address member barriers to complying with the THSteps periodicity schedule. TCHP encourages providers to emphasize the importance of preventive care and...

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