Author - Texas Children's Health Plan

Provider Alert! Health Insurance Portability and Accountability Act (HIPAA) Compliant Reasons for Denials and Adjustments

Attention:  All Providers Health Insurance Portability and Accountability Act (HIPAA) Compliant Reasons for Denials and Adjustments   Beginning May 15, 2019, Texas Children’s Health Plan (TCHP) providers will see positive changes to their HIPAA standard 835 electronic remittance and paper explanations of payments (EOPs). TCHP will be providing more robust and HIPAA compliant messages by utilizing national standard claim adjustment reason codes (CARCs) and remittance advice remark codes (RARCs). What are CARCs and RARCs? CARCs and RARCs are industry standard code sets used to [...]

Perspectives on E-Cigarettes Webinar

If you take care of children in your practice, or have children of your own who are or will be teenagers, check out the American Thoracic Society’s latest webinar on e-cigarettes: “Perspectives on E-Cigarettes”. Presented by toxicologist Dr. Ilona Jaspers, PhD, this webinar will: Equip you with knowledge and strategies to deter teenagers from nicotine addiction and Provide helpful information on adolescents and e-cigarette use that you can incorporate into your practice Click here to view the webinar now!

May is Mental Health Awareness Month

May is Mental Health Awareness Month Year after year, more and more Americans face the reality of living with a mental illness. Despite their age, many young children show early signs of mental illness. These mental health problems are often clinically diagnosable, and can be a product of the interaction of biological, psychological, and social factors. “Half of all mental health disorders show first signs before a person turns 14 years old, and three quarters of mental health disorders begin [...]

May 30 CME “Autism — Not Just a Checklist”

Save the date Texas Children’s Health Plan Grand Rounds CME Series Autism – Not Just a Checklist Target Audience: Texas Children’s Health Plan contracted behavioral health providers. Educational methods will include lectures with question and answer sessions. This activity is approved for a maximum of 2.0 AMA PRA Category I Credit(s). Thursday, May 30, 2019 5:30 p.m. Registration and Dinner 6 p.m. Scientific Session Activity Director: Lia Rodriguez, MD, FAAP Medical Director, Texas Children’s Health Plan Speakers: Bob Voigt, MD Chief of Services, Developmental Pediatrics Director, Autism Center, Texas Children’s [...]

Provider Alert! Texas Children’s Health Plan Claim Editing System Update

Attention:  All Providers Reminder: Texas Children’s Health Plan Claim Editing System Update   Texas Children’s Health Plan (TCHP) previously sent a Provider Alert notifying providers that an intended transition to a new Claims Editing System (CES) by Optum was to occur in December 2018. Please be advised that this transition will now be occurring May 31, 2019.  Any claims submitted May 31, 2019 and after, including corrected and adjusted claims, will be processed with the Optum CES edits. TCHP is required by Texas [...]

Appointment Availability Standards

Appointment availability standards What are appointment availability standards? How do you as a provider with Texas Children’s Health Plan play a role? In 2015 Senate Bill 760 passed, requiring Texas Health and Human Services Commission (HHSC) to monitor the provider networks of managed care organizations. Texas Children’s Health Plan would like to ensure members are able to schedule appointments with providers in accordance with the HHSC’s appointment accessibility guidelines.                                                 AFTER HOURS: Primary Care Physicians who are accessible 24 hours a day, seven [...]

Texas Children’s Health Plan partners with Baylor College of Medicine to address and prevent opioid abuse in perinatal populations

Women of childbearing age have been disproportionately impacted by the opioid epidemic. Consequently, the rates of in utero drug exposure and Neonatal Abstinence Syndrome have increased dramatically over the last decade.  In Texas, overdose is the leading cause of maternal death in the first postpartum year. To prevent and respond to these issues, faculty from Baylor College of Medicine and Texas Children’s Health Plan were recently awarded funding from the Office of National Drug Control Policy’s grant program entitled Combating [...]

Prior Authorization Reference Information

The Texas Children’s Health Plan website now has an additional resource for information related to prior authorization requirements. The Prior Authorization Reference Information documents the codes that require authorization for payment based on authorization category. This list is not yet all-inclusive. It can be found at: https://www.texaschildrenshealthplan.org/sites/default/files/pdf/PA%20Code%20List%20December%202018.pdf In addition, providers can submit an authorization request online for the codes listed on the Prior Authorization Reference Information document via Clear Coverage. For access to or training on the use of Clear [...]

Update to Children’s Services Handbook THSteps Medical Checkups

Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, pre-certification, referrals, and claims/encounter data filing may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the client's specific MCO for details. Beginning February 1, 2019, TMHP will update the Texas Medicaid Provider Procedures Manual, Volume 2, Children’s Services Handbook, subsection 5.3.6 “Texas Health Steps Medical Checkups,” to remove the referral indicator requirement [...]

Provider Alert! Governor Greg Abbott Issues Disaster Declaration for Cherokee, Freestone, Houston, Leon, Madison, Nacogdoches, Robertson, San Augustine, and Shelby Counties.

On April 18, 2019: Governor Greg Abbott issued a disaster declaration for the following counties Cherokee, Freestone, Houston, Leon, Madison, Nacogdoches, Robertson, San Augustine, and Shelby counties. If a member resides in one of these impacted areas named above Texas Children’s Health Plan will make every effort to assist them in obtaining medically necessary services. PHARMACY: Navitus Pharmacy update related to disaster declaration: Navitus has implemented the "Disaster Declaration and Refill Too Soon" process as a result of the severe weather, including thunderstorms and tornado [...]