Author - Texas Children's Health Plan

Provider Alert!

Provider Alert! Drug Regimen Optimization Edit Removed After September 12

Date: September 20, 2022 Attention: All Providers Effective Date: September 12, 2022 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated with 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: Beginning September 12, 2022, Texas Children's Health Plan (TCHP) will remove the Drug Regimen Optimization prior authorization for all drugs except ADHD drugs. The [...]

Provider Alert!

Provider Alert! Prior Authorization Criteria Update for Adakveo

Date: September 20, 2022 Attention: All Providers Effective Date: December 1, 2022 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated with 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 December 1, 2022, the Health and Human Services Commission (HHSC) will update prior authorization criteria for Adakveo (procedure code J0791). HHSC updated the [...]

Provider Alert!

Provider Alert! Prior Authorization Criteria Update for Zolgensma

Date: September 20, 2022 Attention: All Providers Effective Date: November 11, 2022 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated with 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 inform providers that effective November 1, 2022, the Health and Human Services Commission (HHSC) will update [...]

Provider Alert!

Provider Alert! Temporary Change in PDL Status for Antihypertensives, Sympatholytics Drug Class

Date: September 26, 2022 Attention: All Providers Effective Date: September 26, 2022 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: The Health and Human Services Commission (HHSC) is aware of a drug shortage for Catapres-TTS patches in the Antihypertensives, Sympatholytics drug class due [...]

Provider Alert!

Provider Alert! Age and Diagnosis Restriction Updates for Cabenuva, Oncaspar, Zulresso

Date: September 22, 2022 Attention: All Providers Effective Date: October 1, 2022 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated with 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’s (TCHP) would like to inform providers that effective October 1, 2022, the age and diagnosis restrictions for Cabenuva (J0741), Zulresso [...]

Provider Alert!

Provider Alert! Provider Information and Resources on CHIRP, DPP BHS, RAPPS and TIPPS

Date: September 23, 2022 Attention: All Providers Subject: Provider Information and Resources on CHIRP, DPP BHS, RAPPS and TIPPS Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated with 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: Below is information from the Health and Human Services Commission (HHSC) regarding the Comprehensive Hospital Increase Reimbursement [...]

Provider Alert!

Provider Alert! Clinical Practice Guidelines Resource Reminder

Date: September 21, 2022 Attention: All Providers 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: The purpose of this communication is to remind providers about their access to Texas Children’s Health Plan’s (TCHP) Clinical Practice Guidelines and to inform of updated guideline [...]

Provider Alert!

Provider Alert! Case Management for Children and Pregnant Women (CPW) Carve-In  

Date: September 16, 2022 Attention: All Providers Effective date: September 1, 2022 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: The purpose of this communication is to inform our providers of the Case Management for Children & Pregnant Women (CPW) carve-in to Medicaid that [...]

Provider Alert!

Provider Alert! Medicaid Preferred Drug List and Formulary Changes

Date: September 14, 2022 Attention: All Providers Effective Date: July 28, 2022 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated with 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 inform providers that the Texas Vendor Drug Program (VDP) implemented changes to the state Medicaid drug [...]

Provider Alert!

Provider Alert! Private Duty Nursing Fee Schedule Review

Date: September 13, 2022 Attention: Private Duty Nursing providers 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) is aware that some providers are seeing reduced payments for Private Duty Nursing (PDN) claims with dates of service on or after [...]