Author - Texas Children's Health Plan

Provider Alert!
16Feb

Provider Alert! Gene Expression Profiling Procedure Code 81520 to Become a Benefit Effective April 1, 2022

Date: February 9, 2022 Attention: Providers Subject: 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 September 11, 2020, Texas HHSC received a medical benefit request to add Prosigna®, a type of gene expression profiling, as a benefit of Texas Medicaid. Prosigna®...

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Provider Alert!
11Feb

Provider Alert! 2022 Healthcare Common Procedure Coding System (HCPCS) Update

Date: February 11, 2022 Attention: All Providers Effective Date: January 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: Texas Children’s Health Plan (TCHP) aligns with the Healthcare Common Procedure Coding System (HCPCS) additions, revisions, and discontinuations that are implemented for claims processing by TMHP...

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10Feb

Provider Alert! COVID-19 Vaccine Administration Procedure Code 0073A is now a Benefit

Date: February 9 , 2022  Attention: All Providers    Effective date: January 3, 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: Effective for dates of service on or after January 3, 2022, COVID-19 vaccine administration code 0073A is a benefit of Medicaid and CHIP...

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04Feb

Provider Alert! Monoclonal Antibody Therapy Procedure Codes for COVID-19 Treatment Added to Texas Medicaid Benefits

Date: February 2, 2022 Attention: All Providers Effective Date: December 8, 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: On December 8, 2021, the U.S. Food and Drug Administration issued an Emergency Use Authorization (EUA) for the AstraZeneca product Evusheld (tixagevimab co-packaged with cilgavimab),...

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03Feb

Provider Alert! COVID-19 Vaccine Booster Update

Date: January 31, 2022 Attention: All Providers Effective Date: January 3, 2022 for Pfizer COVID-19 Vaccine Booster Dose Age Change 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 January 3, 2022, the U.S. Food and Drug Administration (FDA) amended the emergency use authorization (EUA)...

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Provider Alert!
02Feb

Provider Alert! Inclement Weather Update

Date: February 2, 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: Texas Children’s Health Plan (TCHP) is closely monitoring the inclement weather that is forecasted to impact our Service Delivery Areas of Harris, Jefferson, and Northeast, later this week. As always,...

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Provider Alert!
28Jan

Provider Alert! New Autism Services Benefit for Medicaid Recipients

Date: January 28, 2022 Attention: Primary Care Providers, Developmental Pediatricians, and Neurologists Effective Date: February 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: Effective for dates of service on or after February 1, 2022, Autism Services, to include Applied Behavior Analysis (ABA) evaluation...

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Provider Alert!
28Jan

Provider Alert! Removal of Specialist Requirement from Clinical Prior Authorization Criteria

Date: January 28, 2022 Attention: Providers Effective Date: January 3, 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: Effective January 3, 2022, HHSC removed the specialist requirement from the following clinical prior authorization criteria: CGRP Antagonist, Acute CGRP Antagonists, Chronic Emflaza Ophthalmic Immunomodulators Palforzia Transthyretin Agents VMAT2 Inhibitors Wakix Xyrem/Xywav Zelboraf How this impacts providers: Providers...

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Provider Alert!
28Jan

Provider Alert! Prior Authorization Criteria for Enzyme Replacement Therapy

Date: January 28, 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: Effective March 1, 2022, HHSC will require prior authorization for all enzyme replacement therapies for Medicaid and CHIP. Enzyme replacement therapy (ERT) is a medical treatment...

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Provider Alert!
28Jan

Provider Alert! Respiratory Syncytial Virus (RSV) Season Ends February 1st

Date: January 28, 2022 Attention: Primary care providers Effective Date: February 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: HHSC will close the respiratory syncytial virus (RSV) season in all regions on February 1st, 2022. The 2021-22 traditional RSV season began on October 1, 2021,...

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