Author - Texas Children's Health Plan

Provider Alert!
12Apr

Provider Alert! March 2022 Specialty Drug List Available

Date: April 7, 2022 Attention: Providers Effective Date: March 31, 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 March 2022 Biannual Specialty Drug List is now available from the Vendor Drug Program Website. How this impacts providers: A drug must meet all four of the...

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Provider Alert!
12Apr

Provider Alert! Texas Health Steps Quick Reference Guide Updated for March 2022

Date: April 7, 2022 Attention: Primary Care Providers 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. TCHP will apply updates and reprocess impacted claims as soon as possible. However, please allow up to sixty (60) business days for reprocessing. Providers are not required to appeal claims...

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Provider Alert!
12Apr

Provider Alert! Benefit Criteria for Evoked Response Tests and Neuromuscular Procedures Update

Date: April 7, 2022 Attention: Neurologists Effective date: March 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. TCHP will apply updates and reprocess impacted claims as soon as possible. However, please allow up to sixty (60) business days for reprocessing. Providers are not required to...

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Provider Alert!
12Apr

Provider Alert! Update to Prostate Procedures for Benign Prostatic Hyperplasia Benefit Criteria

Date: April 7, 2022 Attention: Urologists Effective date: October 1, 2021 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. TCHP will apply updates and reprocess impacted claims as soon as possible. However, please allow up to sixty (60) business days for reprocessing. Providers are not required to...

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Provider Alert!
11Apr

Provider Alert! Laser Interstitial Thermal Therapy to Require Prior Authorization

Date: April 6, 2022   Attention: Radiologists Effective date: July 5, 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. Regarding system configuration updates, TCHP will apply updates and reprocess impacted claims as soon as possible. However, due to volume, please allow up to sixty (60) business days...

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Provider Alert!
06Apr

Provider Alert! Age Range Updates for Drug Procedure Codes Effective April 1

Date: April 6, 2022 Attention: Providers Effective Date: April 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: On April 1, 2022, HHSC updated age ranges for drug procedure codes Q0167, Q0169, and Q0175 for Medicaid and CHIP. How this impacts providers: Dronabinol (procedure code Q0167)...

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Provider Alert!
06Apr

Provider Alert! Age and Diagnosis Restriction Updates for Drug Procedure Codes, Effective March 1

Date: April 6, 2022 Attention: Providers Effective Date: March 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: On March 1, 2022, HHSC updated age and diagnosis restrictions for drug procedure codes J0596, J0598, J0599, and J9348 for Medicaid and CHIP. Fee-for-service criteria for J0596,...

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Provider Alert!
06Apr

Provider Alert! External Medical Review Provider Training now available

Date: April 5, 2022 Attention: All Providers Effective date: February 28, 2022 Call to action: TCHP would like to inform providers of training on External Medical Review (EMR) available from the Health and Human Services Commission. The purpose of this training is to provide an overview to providers on the role/responsibilities for participants involved in an EMR following receipt of an Adverse Benefit Determination from a MCO or dental contractor. TCHP follows the guidance on (EMR) in accordance with the Uniform Managed Care...

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Provider Alert!
04Apr

Provider Alert! Provider enrollment revalidation extension has ended

Date: March 29, 2022 Attention: All providers Effective Date: March 29, 2022 The extension for revalidation due dates for currently enrolled providers ended on February 28, 2022 as announced by the Health and Human Services Commission (HHSC). TCHP COVID-19 Utilization Management Procedure and provider alerts can be found here: http://www.thecheckup.org/provider-alerts/ 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...

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04Apr

Provider Alert! CHIP co-pays waived for office visits in response to COVID-19

Date: March 29, 2022 Attention: All Providers Effective Date: March 29, 2022 The content in this message will remain in effect through April 30, 2022 as announced by the Health and Human Services Commission. TCHP COVID-19 Utilization Management Procedure and provider alerts can be found here: http://www.thecheckup.org/provider-alerts/ 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...

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