Monthly Archives - December 2023

Provider Alert!
07Dec

Provider Alert! Coverage of Adstiladrin (procedure code J9029) Begins January 2024; Prior Authorization Effective February 2024

Date: December 6, 2023 Attention: All Providers Prior Authorization Effective Date: February 1, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective February 1, 2024, Texas Health and Human Services (HHSC) will be implementing prior authorization criteria for Adstiladrin (procedure code J9029). Adstiladrin (nadofaragene firadenovec-vncg) is an adenoviral vector-based gene therapy indicated to treat adult clients with high-risk Bacillus Calmette-Guérin (BCG)-unresponsive non-muscle invasive bladder cancer (NMIBC) with carcinoma in situ (CIS) with or without papillary...

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Provider Alert!
07Dec

Provider Alert! Fee-for-Services (FFS) Telephone (Audio-Only) Telemedicine Services for Non-Behavioral Health Conditions

Date: December 7, 2023 Attention: All Providers Effective for dates of service on or after November 1, 2023 Call to action: The purpose of this communication is to offer information about the implementation of a new telemedicine services delivery method for certain non-behavioral health conditions. How this impacts providers: The following office and other outpatient telemedicine services may be provided by synchronous telephone (audio-only) technology for the diagnosis, evaluation, and treatment of non-behavioral health conditions if clinically appropriate and safe, as determined by the...

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05Dec

Provider Alert! Coverage of Commercialized COVID-19 Vaccines Begins as a Pharmacy Benefit

Effective Dates: As of September 11, 2023 & October 3, 2023 Date: December 4, 2023 Attention: All Providers Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective for dates of service on or after September 11, 2023 and October 3, 2023, the U.S. Food and Drug Administration’s (FDA) issued approval and Emergency Use Authorization (EUA) for the following COVID-19 vaccines: As of September 11, 2023: 2023-2024 Pfizer-BioNTech COVID-19 Vaccine 2023-2024 Moderna COVID-19 Vaccine As of October 3, 2023: 2023-2024 Novavax COVID-19 Vaccine The...

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Provider Alert!
05Dec

Provider Alert! Synagis (palivizumab) Clinical Prior Authorization Forms Updated with Revised Abrysvo Criteria

Date: December 4, 2023 Attention: All Providers Effective date: November 17, 2023 Call to action: On November 17, 2023, Health and Human Services Commission (HHSC) updated the Synagis Standard Prior Authorization Request (HHS Form 1321) to include a step to check for Abrysvo vaccine administration to the client’s mother during 32 to 36 weeks of pregnancy. How this impacts providers: Additional information on Abrysvo Vaccine include the following: Abrysvo is indicated for active immunization of pregnant individuals at 32 through 36 weeks gestational age for...

By OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialists, Uncategorized, , , 0 CommentsRead more...
Provider Alert!
04Dec

Provider Alert! Meet Your New Quality Consultants to Support our Provider Network

Date: December 4, 2023Attention: All Providers Event dates are as follows:Session 1: December 19, 2023Session 2: December 21, 2023Session 3: January 8, 2024 All sessions will be will be from 12:00PM (Noon) – 1:00PM CST Introduction: The Provider Relations department would like to invite you to attend one of the upcoming sessions and introduce you to the new Quality Team that will support you and your practice to ensure optimal provider experience and performance for 2024. Sessions will be held online as a...

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Provider Alert!
01Dec

Provider Alert! Coverage of Elevidys Begins January 2024 

Date: November 30, 2023  Attention: All Providers  Prior authorization effective date: February 1, 2024 Call to action: The purpose of this communication is to inform providers that on January. 1, 2024, Elevidys will become a benefit of Medicaid and CHIP. Health and Human Services commission (HHSC) will require prior authorization for Elevidys (procedure code J1413) for Medicaid and CHIP, effective February 1, 2024. Elevidys is an adeno-associated virus vector-based gene therapy indicated for the treatment of ambulatory pediatric clients ages 4 through 5 years...

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