Author - Texas Children's Health Plan

Provider Alert! Signature Requirement Reinstated on DME Forms

Date: January 19, 2022 Attention: DME Providers Subject: Signature Requirement Reinstated on DME Forms TCHP COVID-19 Utilization Management Procedure and TCHP provider alerts can be found here: http://www.thecheckup.org/provider-alerts/ TCHP network providers should monitor the 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 1, 2022, a member or member’s authorized representative’s signature is required on DME...

Provider Alert!

Provider Alert! Prior Authorization Criteria for Benlysta (J0490)

Date: January 14, 2022 Attention: Oncology 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: Beginning March 1, 2022, Benlysta (procedure code J0490) will be available for Medicaid members as a medical benefit. Benlysta (belimumab) is indicated to treat active, autoantibody-positive,...

Provider Alert!

Provider Alert! Stimate Nasal Spray National Drug Shortage

Date: January 14, 2021 Attention: All Providers Subject: Stimate Nasal Spray National Drug Shortage Effective date: December 16, 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: The Texas Health and Human Services Comission (HHSC) was made aware of a voluntary recall issued by Ferring Pharmaceuticals for...

Provider Alert!

Provider Alert! Prior Authorization Criteria for Saphnelo (C9086)

Date: January 14, 2022 Attention: Oncology 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: Beginning March 1, 2022, Saphnelo (procedure code C9086) will be available for Medicaid members as a medical benefit. Saphnelo (anifrolumab-fnia) is indicated to treat moderate to...

Provider Alert!

Provider Alert! Date: Pneumococcal Vaccine Procedure Codes 90671 and 90677 Become Benefits of Texas Medicaid

Date: January 13, 2022 Attention: Primary Care 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: The U.S. Food and Drug Administration (FDA) approved the use of PREVNAR 20 (procedure code 90677) on June 10, 2021 and the use of VAXNEUVANCE...

Provider Alert! COVID-19 At-home Test Kits Available as a Pharmacy Benefit

Date: January 4, 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: HHSC will allow COVID-19 at-home test kits as a Medicaid and Children’s Health Insurance Program (CHIP) pharmacy benefit beginning January 3, 2022. Members may obtain COVID-19 at-home...

Provider Alert! Pfizer Oral COVID-19 Drug, Paxlovid, Added to Formulary

Date: January 5, 2022 Attention: All Providers Effective Date: December 27, 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: Health and Human Services Commission (HHSC) added Paxlovid to the Medicaid and Children’s Health Insurance Program (CHIP) formulary as a payable pharmacy benefit on December 27,...

Provider Alert!

Provider Alert! Texas Children’s Health Plan’s Cultural Competency Plan and Learning Opportunity

Date: January 3, 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 fosters an environment of diversity, equity and inclusion by providing the right resources for our network of providers to better serve our culturally diverse member population....

Provider Alert!

Provider Alert! Electronic Visit Verification (EVV) Policy Handbook Revisions  

Date: December 21, 2021 Attention: Financial Management Services Agencies and Consumer Directed Services employers 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: Texas Children’s health Plan would like to make providers aware that revisions to the Electronic Visit Verification Policy...

Provider Alert! CHIP Perinatal Members Eligible for COVID-19 Vaccine

Date: December 20, 2021 Attention: All Providers Effective Date: December 11, 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: Effective December 11, 2020, CHIP Perinate members enrolled in CHIP Perinatal services are eligible to receive the COVID-19 vaccine. The CHIP Perinatal (CHIP-P) Program serves the...