Author - Texas Children's Health Plan

Provider Alert!

Provider Alert! Subject: Codes: K0108, A9900, and E1399 Wheelchair Guideline

Attention: All Providers Effective Date: October 22, 2020 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event. In follow-up to our Provider Alert posted on 7/13/2020 regarding wheelchair accessories, Texas Children’s Health Plan did not implement changes to the current process for prior authorization of codes:  K0108, A9900, and [...]

Provider Alert!

Provider Alert! Texas Children’s Health Plan Special Investigations Unit and Claims Payment Review Information

Attention: All Providers Effective Date: October 23, 2020 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event. Call to action: Texas Children’s Health Plan (TCHP) would like to share information with our provider network on two important topics, the Special Investigation Unit and Claims Payment Reviews. What is the [...]

Provider Alert! Texas Children’s Health Plan to host live CME Event

Paying Attention to ADHD: Diagnosis, Treatment & Resources  Texas Children’s Health Plan is hosting a new CME: Paying Attention to ADHD: Diagnosis, Treatment & Resources. This is a free CME for contracted family practice and pediatric providers that will offer two course credits   Thursday, October 29, 2020 – 5:30-7:30 p.m. – Live stream via WebEx   Topics covered will include: Diagnosis and treatment of ADHD Community supports & resources Pharmacy navigation with the state formulary What is CPAN [...]

Provider Alert!

Provider Alert! Attention: NCQA HEDIS Measure Changes

Attention: PCP, OB/GYN and Endocrinologist Providers Effective Date: January 1, 2020 Call to action: Texas Children’s Health Plan (TCHP) would like to inform you of changes to the National Committee for Quality Assurance (NCQA) HEDIS Technical Specifications released on July 1st, 2020. How this impacts providers: These changes are effective as of January 1, 2020. Please submit all claims timely, as soon as services are rendered, and use appropriate codes to reflect the services provided particularly for Well-Care Visits and THSteps. REVISED MEASURES Well-Child Visits [...]

HEDIS Toolkit Offers Benefits to Providers

Members are cared for as HEDIS measures are met  Texas Children’s Health Plan developed a HEDIS Toolkit that contains helpful information regarding the measure requirements, standards and codes to use that are acceptable for HEDIS reporting. The new toolkit can be accessed here. This toolkit will serve as a reference form that can be used to code the type of appointments made and ensure that all of the HEDIS standards are met.  This will help providers maintain high quality care and [...]

Provider Alert!

Provider Alert! Single-Dose Vial Unused Portion Reimbursement Policy for Clinician-Administered Drugs

Attention: All Providers Effective Date: September 1, 2020 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event. Call to action: Texas Children’s Health Plan (TCHP) aligns with Texas Medicaid and Healthcare Partnership (TMHP) regarding the reimbursement policy for the unused portion of a single use vial for clinician-administered [...]

Provider Alert!

Provider Alert! Prior Authorization Guideline updates for Private Duty Nursing (PDN) and therapy specialty services

Attention: All Providers Effective Date: July 18, 2020 for PDN and August 11, 2020 for therapy Services Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event. Call to action: TCHP would like to inform you of recent updates to the prior authorization requirements and the effective dates. Updates [...]

Provider Alert!

Provider Alert! Uniform Opioid Policy Begins September 1

Attention: All Providers Effective Date: September 1, 2020 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event.  Call to action: Effective September 1, 2020, the Vendor Drug Program (VDP) will implement a uniform opioid policy to encourage appropriate use and reduce opioid over-prescribing. The opioid policy does not apply to chronic pain, [...]

Provider Alert!

Reminder: Mandatory PMP verification to prescribe and dispense certain controlled substances

Attention: All Providers Effective Date: August 18, 2020 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event. Call to action: This is a reminder that as of March 1, 2020, pharmacists and prescribers have been required to check the patient’s Prescription Monitoring Program (PMP) history before prescribing or [...]

Is It Anxiety or Does Kevin have COVID 19?

Clinical Vignette: It’s 4 p.m. on a busy Thursday. Kevin and his mother zoom into your office for the third time in six weeks. Today’s chief complaint is stomach pain and mild diarrhea. Kevin is 9 years old and has had some stomach issues in the past. His mother has been reading up on COVID-19 and heard that children more often present with stomach versus respiratory symptoms. The history does not really fit COVID-19 and you are starting to wonder [...]