Author - Texas Children's Health Plan

Provider Alert!

Provider Alert! TCHP Fax Lines Availability: Fax lines open 24/7

Date: January 16, 2020 Attention: TCHP Providers Effective Date: January 6, 2020 Call to action: We are excited to announce that Texas Children’s Health Plan has made updates to the availability of the fax lines for authorization requests. The following outlines a summary of the changes. Beginning January 6, 2020, TCHP fax lines are open to receive requests for authorizations 24/7. This is a change to the former procedure to receive faxed requests for authorizations during normal business hours (Monday-Friday, 8a.m. – 6p.m.). Now [...]

Zantac/ranitidine drug recalls due to NDMA impurity

Multiple drug manufacturers have issued voluntary drug recalls for several Zantac drug products and its generic, ranitidine. Ranitidine is a histamine-2 receptor antagonist used to treat heartburn and related conditions. Potentially impacted customers are being notified with a recommendation to stop taking the medication and to discuss alternative therapies with their provider. The recalls are due to discovery of an impurity (N-nitrosodimethylamine [NDMA]) in the finished product. NDMA is classified as a probable human carcinogen that may be found in [...]

Provider Alert!

Provider Alert! Update: Acute Therapy Requests with treatment for less than 60 days, a Texas Health Steps Checkup or Attestation is Not Required

Effective Date: October 31, 2019   Initial specialty therapy (occupational, physical, speech therapy) evaluations do not require prior authorization effective September 1, 2019. However, a current Texas Health Steps checkup performed in the last 12 months or a current well checkup attestation is required for ongoing specialty therapy lasting for greater than 60 days.   How this impacts providers: In an effort to ensure our in-network providers can provide specialty therapy evaluations within 21 days of submission of a signed referral, Texas Children’s [...]

The Flu and Antiviral Medications

Flu season is here and Texas Children’s Health Plan hopes everyone has received their flu vaccine. If you haven’t gotten your flu vaccine, it’s not too late! When you diagnose a patient with the flu, it’s important to understand when you can treat with antivirals, as well as which antiviral medications are approved and recommended for treatment each flu season. Antiviral medications work best if started within two days of getting sick with the flu. There are currently three antiviral medications [...]

Opioid Abuse CME

Texas Children’s Health Plan Is Offering Free Online Combating Opioid Abuse CME/CNE

Combating Opioid Abuse CME Series Provided by Texas Children’s Hospital and presented by Texas Children’s Health Plan. The Opioid Epidemic and SBIRT This course addresses the epidemiology of the opioid epidemic nationally and locally, as well as effective health care and public health responses. Tackling the Opioid Crisis; Effects on the Neonate Identify newborns at risk for NAS/NOWS, recognize the symptoms of NAS and discuss treatment options, and learn potential long-term sequelae of fetal exposure to opioids. Tackling the Opioid Crisis: An OB Perspective This class [...]

Provider Alert!

Provider Alert! Acute Therapy Services

Acute Therapy Services Requests for acute occupational speech and physical therapy services will require documentation from the prescribing provider that a visit for the acute injury or acute exacerbation of the medical condition requiring therapy has occurred within the last 90 days. Acute speech therapy authorization will not require evidence of current Texas Health Steps well checkup for therapy treatment requests of 60 days or less. Therapy services for greater than 60 days will require evidence that the member is current in [...]

Provider Alert!

Provider Alert! Syphilis testing laws updated effective 9/1/2019

Texas law now mandates three syphilis tests for all pregnant women: at the first prenatal exam, during the third trimester (no earlier than 28 weeks gestation), and at delivery.  This new testing is required because congenital syphilis cases reported to the Texas Department of State Health Services (DSHS) more than doubled last year.  There were 367 cases of congenital syphilis in Texas in 2018, up from 164 in 2017. The increase in reported cases is likely due to a [...]

Provider Alert!

Provider Alert! Dental Varnish Services

Date: October 16, 2019 Attention: Primary Care Providers Subject: Dental Varnish Services Call to action: Texas Children’s Health Plan (TCHP) identified an error in the reimbursement of dental varnish services.  This error may have resulted in non-payment of this service during a medical checkup for TCHP members who are 6 to 35 months of age.  An update to TCHP’s claims payment system is currently in process and all impacted claims will be reviewed and reprocessed for payment within the next 30 days. How [...]

Provider Alert!

Provider Alert! Reimbursement Rate Changes for PCS, PDN & Therapy Services

Date: October 16, 2019 Attention: Home Health, Therapy and LTSS Providers Subject: Reimbursement Rate Changes for PCS, PDN & Therapy Services Effective Date: September 1, 2019 Call to action: On August 28, 2019, Texas Children’s Health Plan (TCHP) received notice of the rate changes from Texas Medicaid Healthcare Partnership (TMHP) effective September 1, 2019.  The services impacted by the Medicaid-implemented rate changes include: Personal Care Services (PCS) Private Duty Nursing (PDN) Therapies for Children in the Home Therapy Assistants TCHP is in the process of implementing the updates [...]