Author - Texas Children's Health Plan

Provider Alert!

Provider Alert! Online Authorization Platform is Now Operational

Date: January 13, 2021 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: Texas Children’s Health Plan (TCHP) would like to inform providers that utilize our online authorization platform; Health Trio this platform is restored and is now functional and accepting authroizations. How [...]

Provider Alert!

Provider Alert! Essential Information for Prior Authorization Submission

Date: January 13, 2021 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: Texas Children’s Health Plan (TCHP) would like to remind network providers of the required information for a prior authorization submission. The Texas Standard Prior Authorization Form* including the following information: Member [...]

Provider Alert! COVID-19 Disaster Declaration – COVID-19 Testing expanded to include Out-of- Network (OON) Laboratories

Date: January 7, 2021 Attention: All Provider Notice Effective Date: NEW update for dates of service on or after October 6, 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. The content in this message will remain in effect throughout the COVID-19 Disaster Declaration period as announced by [...]

Provider Alert!

Provider Alert! Prior Authorization Re-certification Requests Submission for Texas Medicaid

Date: January 7, 2021 Attention: Therapy Providers Effective Date: October 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 the guidance on prior authorization (PA) recertification requests. In compliance with House Bill 3041 of the 86th Texas [...]

Provider Alert!

Provider Alert! New prior authorization requirements for Omalizumab (Xolair)

Date: December 23, 2020 Attention: Allergists & Immunologists, Pulmonologists Effective Date:  February 1, 2021 Call to action: Texas Children’s Health Plan (TCHP) is aligning prior authorization criteria for omalizumab (Xolair), J2357, with the Texas Medicaid Provider Procedures Manual (TMPPM). Xolair is a clinician administered drug indicated for members with moderate to severe persistent asthma or chronic idiopathic urticaria (CIU) who remain symptomatic despite H1 antihistamine treatment. Below are the new prior authorization criteria for TCHP members effective 2/1/2021. For initial therapy, the [...]

Provider Alert!

Provider Alert! New prior authorization requirements for Mepolizumab (Nucala)

Date: December 21, 2020 Attention: Allergists & Immunologists, Pulmonologists Effective Date:  February 1, 2021 Call to action: Texas Children’s Health Plan (TCHP) is aligning prior authorization criteria for mepolizumab (Nucala), J2182, with the Texas Medicaid Provider Procedures Manual (TMPPM). Mepolizumab (Nucala) is a clinician administered drug indicated for members with severe asthma with an eospinophilic phenotype.   Mepolizumab (Nucala) is also indicated as a steroid sparing agent for certain types of hypereosinophilic syndrome (HES) and eosinophilic granulomatosis with polyangiitis (EGPA). Below are the new [...]

Provider Alert! COVID-19 Procedure Codes for the Introduction of Infusion of Therapeutics

Date: January 6, 2021 Attention: All Providers Effective Date: For dates of service on or after August 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 the Centers for Medicare & Medicaid Services (CMS) in response to [...]

Provider Alert! New Online Authorization Platform for Providers

Attention: All Providers Effective Date: January 1, 2021 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 inform our network providers that currently have access to Clear Coverage, our online authorization tool, that beginning January 1, 2021; [...]

OB Provider Incentive Program Updates

Texas Children’s Health Plan offers an OB Provider Incentive Program to reward your OB provider group for providing quality care to our members during their pregnancy, from early prenatal care to delivery and timely postpartum care. Learn how the program works: 2021 OB Provider Incentive Program Brochure 2022 OB Provider Incentive Program Brochure

Provider Alert!

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

Attention: All Providers Effective Date: October 22, 2020; March 1, 2021 for information pertaining to Code A9900 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 [...]