Monthly Archives - August 2023

Provider Alert!
31Aug

Provider Alert! Hepatitis C Resources for Your Patients

Date: August 25, 2023 Attention: All Providers Call to action: Texas Children’s Health Plan (TCHP) would like to make providers aware of new resources on Hepatitis C available from the Health and Human Services Commission (HHSC) available to your Medicaid patients with the named diagnosis. The resources were created to increase the awareness for treating Hepatitis C. How this impacts providers: The new resources are available below for your Medicaid patients. Hep C Notice English                       Hep C Notice Spanish   Resources: ●      txvendordrug.com/formulary/hepatitis-c ●      hhs.texas.gov/services/health/prevention/hepatitis-c-treatment Previously published communication...

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Provider Alert!
30Aug

Provider Alert! Radiology Benefit Updates for Texas Medicaid Effective September 1, 2023

Date: August 30, 2023 Attention: All Providers Effective Date: September 1, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that certain radiology benefit updates will be effective for Texas Medicaid for dates of service on or after September 1, 2023. Major changes include the following: The addition of benefit information for magnetic resonance elastography (MRE) New benefit for ultrasound transient elastography (TE) MRE (procedure code 76391) may be reimbursed for the diagnosis or monitoring of liver fibrosis or cirrhosis in...

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Provider Alert!
30Aug

Provider Alert! Update on the Inpatient Claims Review Process

Date: August 30, 2023 Attention: Hospital Providers and Inpatient Facilities for All Lines of Business The purpose of this communication is to provide information related to prepayment claims review. As communicated in a previous Provider Alert, Texas Children’s Health Plan (TCHP) has engaged Optum Health to perform routine prepayment claims reviews. As a result, providers may be required to submit medical records and itemized billing statements that support the charges billed and are encouraged to submit this information upon original submission of...

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Provider Alert!
29Aug

Provider Alert! Medicaid Re-enrollment: Patients May Risk Losing Their Medicaid Plan!

Date: August 28, 2023 Attention: All Providers Call to action: Texas Children’s Health Plan (TCHP) would like to thank you for supporting your patients with maintaining coverage during the Medicaid re-enrollment currently underway. Background information: As you may know, Medicaid coverage rules have changed, and some Medicaid recipients 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...

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Provider Alert!
29Aug

Provider Alert! You’re Invited to Our Provider Advisory Group!

Date: August 29, 2023 Attention: All Providers Thursday, September 21, 2023 Northeast SDATuesday, September 26, 2023 Jefferson SDAThursday, September 28, 2023 Harris SDANEW TIME: All sessions will be from 12:00PM (Noon) – 1:30PM CST Call to action: Texas Children’s Health Plan (TCHP) invites you to join our quarterly Provider Advisory Group (PAG). We will hold our next round of sessions next month and dates are based on Service Delivery Area (SDA) as described above. Click here if you are not sure of your SDA....

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Provider Alert!
28Aug

Provider Alert! Non-Risk Based Status for Zynteglo Began July 1, 2023

Date: August 28, 2023 Attention: Physicians Effective Date: July 1, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to let you know that effective July 1, 2023, reimbursement for Zynteglo is non-risk. Zynteglo (procedure code J3590) is a gene therapy for treating adult and pediatric clients with beta-thalassemia requiring regular blood cell (RBC) transfusions. How this impacts providers: Zynteglo is administered in a qualifying treatment center (QTC) for clients that meet prior authorization criteria. QTC is required to send the prescription to...

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Provider Alert!
28Aug

Provider Alert! HHSC to Add Skysona® as Medicaid and CHIP Benefit July 1, 2023, Prior Authorization Effective September 1, 2023

Date: August 24, 2023 Attention: All Providers Effective Date: September 1, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective September 1, 2023, the Texas Health and Human Services (HHSC) will be implementing required prior authorization criteria for Skysona® (procedure code J3590) for Medicaid and CHIP. Skysona® will become a benefit of Medicaid and CHIP on July 1, 2023. Skysona® (betibeglogene autotemcel) is indicated to slow the progression of neurologic dysfunction in boys 4-17 years...

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Provider Alert!
23Aug

Provider Alert! CHIP $20,000 CAP for Durable Medical Equipment (DME), Prosthetic Devices and Disposable Medical Supplies Now Active

Date: August 22, 2023 Attention: CHIP Providers Effective date: May 23, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that in accordance with the Uniform Managed Care Manual, for CHIP Members, there is a $20,000 12-month period limit for DME, prosthetics, devices and disposable medical supplies limitation (diabetic supplies and equipment are not counted against this cap). Covered services require prior authorization and physician prescription when in excess of benefit limitations for members 20 years of age...

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Provider Alert!
22Aug

Provider Alert! Credentialing reminder for PCPs Administering Allergen Immunotherapy Services

Date: August 22, 2023 Attention: Primary Care Providers (PCPs) Call to action: Texas Children’s Health Plan (TCHP) would like to remind Primary Care Providers (PCPs) of the credentialing requirement when administering allergen immunotherapy services. How this impacts providers: Allergy testing and injections will be reimbursed only for PCPs who are credentialed as allergy specialists. An allergist / immunologist (commonly referred to as an allergist) is a physician specially trained to diagnose, treat and manage allergies, asthma and immunologic disorders including primary immunodeficiency disorders. TCHP...

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Provider Alert!
18Aug

Provider Alert! Member Experience Survey Coming Soon

Date: August 17, 2023 Attention: All Providers Effective Date: August 2023 Call to action: Texas Children Health Plan (TCHP) would like to let providers know that later this month your patients may be given a member experience survey. The survey will include questions in regards to, but not limited to, communication, care coordination and access to care. Participation in this survey is voluntary. How this impacts providers: Members’ responses will help create effective, active interventions where we hope to partner with you and better...

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