Monthly Archives - May 2023

Provider Alert!
24May

Provider Alert! Clinical Criteria Revision for Evkeeza® effective June 1, 2023

Date: May 18, 2023 Attention: All Providers Effective Date: June 1, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective June 1, 2023, Texas Health and Human Services (HHSC) will expand coverage for Evkeeza® (procedure code J1305) to adolescents 5 years of age and older due to a recent U.S. Food and Drug Administration (FDA) approval. Evkeeza® is an injectable prescription medicine used along with other low-density lipoprotein (LDL) lowering medicines in treating high cholesterol...

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Provider Alert!
24May

Provider Alert! Ensuring Timely Prenatal and Postpartum Visits Reminder

Date: May 17, 2023 Attention: Obstetric Care Providers Call to action: Texas Children’s Health Plan (TCHP) encourages OB/GYNs and other providers to take measures to ensure that your patients, our members, are receiving timely prenatal and postpartum visits. TCHP is committed to optimizing the quality of obstetric care provided to members during pregnancy and the postpartum period. Together, we can support healthy pregnancies, reduce maternal mortality and improve neonatal outcomes.  OB/GYNs and other providers are encouraged to share this communication with their staff...

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19May

Alert Provider! Change in PDL Status for the Smoking Cessation Drug Class Effective May 16, 2023

Date: May 18, 2023 Attention: All Providers Effective Date: May 16, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective May 16, 2023, Texas Health and Human Services Commission (HHSC) removed non-preferred status from the generic product, varenicline, to the preferred drug list (PDL). The preferred status of the brand product Chatnix® (NDC 00069-0468-56, 00069-0471-03, 00069-0469-56) will not change. This is in response to drug shortage for the brand Chantix® due to a...

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19May

Provider Alert! REMINDER: Federal Public Health Emergency Ended May 11, 2023 – Update on COVID Flexibilities

Date: May 19, 2023 Attention: All Providers Call to action: The Health and Human Services Commission (HHSC) updated the COVID flexibilities with several new updates since March 2023 as a result of the public health emergency (PHE) ending. This includes the following: HHSC to End Telephone (Audio-only) Medical Services COVID-19 Guidance and Issue Temporary Guidance for Certain Audio-Only Services Infection Control Supplies Procedure Code S8301 No Longer a Benefit Effective May 12, 2023 Advance Notice of Requirements for the Use of Telecommunications for Service...

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19May

Provider Alert! Clarifying Information on Provider Enrollment and Management System (PEMS)

Date: May 18, 2023 Attention: All Providers Master Provider File effective date: To Be Determined 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. Clarifying information on PEMS can be found here: https://www.tmhp.com/news/2023-05-16-provider-enrollment-and-management-system-pems-post-deployment-update Providers are strongly encouraged to visit this site for an overview of...

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19May

Provider Alert! Important Reminder about Medicaid Re-enrollment and How Providers Can Assist Their Patients

Date: May 19, 2023 Attention: All Providers Effective Date: Ongoing Call to action: Texas Children’s Health Plan (TCHP) would like to remind providers that the Medicaid coverage rules have changed, and some Medicaid recipients will need to go through the renewal process to determine their eligibility for coverage. This is the result of the Consolidated Appropriations Act, 2023 (CAA, 2023) that was enacted on December 29, 2022. The CAA ended the auto-renewals for Medicaid. Starting April 2023, some of our Texas Children’s Health...

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16May

Provider Alert! COVID-19 Vaccine Administration Procedure Code 0174A Is Now a Benefit of Medicaid and CHIP

Date: May 16, 2023 Attention: All Providers Effective date: Dates of service on or after March 14, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective for dates of service on or after March 14, 2023, in accordance with the U.S. Food and Drug Administration’s amended Emergency Use Authorizations, COVID-19 vaccine administration procedure code 0174A for the administration of the Pfizer-BioNTech COVID-19 vaccine booster is now a benefit of Texas Medicaid and CHIP for individuals 6...

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16May

Provider Alert! Infection Control Supplies Procedure Code S8301 No Longer a Benefit

Date: May 16, 2023 Attention: All Providers Effective Date: May 12, 2023 Call to action: Texas Children Health Plan (TCHP) would like to inform providers that effective with the end of the federal public health emergency (PHE) on May 11, 2023, the Health and Human Services Commission (HHSC) will end multiple temporary flexibilities related to the COVID-19 pandemic. Providers should be aware that this change impacts coverage and reimbursement for procedure code S8301for infection control supplies. Effective for dates of service on or after May...

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15May

Provider Alert! End of COVID flexibilities: Provider Signatures for All Therapy Services and Hearing Screening for Speech Therapy

Date: May 15, 2023 Attention: All Providers Effective date: June 13, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to make providers aware of the end to some COVID flexibilities related to Utilization Management.  Background information: The Health and Human Services Commission (HHSC) received notice that the COVID-19 federal public health emergency (PHE) declared on January 31, 2020, will end on May 11, 2023. In response to the PHE, TCHP implemented additional flexibilities during this time that will come to an...

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Provider Alert!
11May

Provider Alert! New EVV Vendor System HHAeXchange Launching October 1, 2023

Date: May 11, 2023 Attention: All Providers Effective Date: October 1, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that a new single state funded Electronic Visit Verification (EVV) vendor system, HHAeXchange, is launching October 1, 2023. On April 26, 2022, the Texas Health and Human Services Commission (HHSC) posted a solicitation for EVV System Management Services. Through a competitive selection process, HHSC has selected Accenture State Healthcare Services LLC. How this impacts providers: Accenture will continue to be known...

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