Author - Texas Children's Health Plan

Provider Alert!

Provider Alert! Subcutaneous Internal Cardiac Defibrillator (S-ICD) to Become a Benefit for Texas Medicaid

Date: August 25, 2021 Attention: Cardiologists Effective Date: September 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: Effective September 1, 2021, subcutaneous internal cardiac defibrillator (S-ICD) procedure codes 33270, 33271, 33273, 33274, 93287, and 93290 will become a benefit for Texas Medicaid. How this impacts...

Provider Alert!

Provider Alert! Diabetic Equipment and Supplies Benefits to Change for Texas Medicaid

Date: December 17, 2021 Attention: Endocrinologists and Primary Care Providers Effective Date: September 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: New information updated December 17, 2021 with an effective date of September 1, 2021, Diabetic equipment and supplies procedure code A9276 sensor...

Provider Alert!

Provider Alert! Lung Cancer Screening Benefits to Change for Texas Medicaid

Date: August 13, 2021 Attention: Primary care Providers Effective Date: September 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: Effective for dates of service on or after September 1, 2021, lung cancer screening benefits will change for Texas Medicaid. Major changes to this medical benefit...

Provider Alert!

Provider Alert! Updates for Prostate Surgeries Procedure Codes

Date: August 24, 2021 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 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 October 1, 2021, reimbursement rate updates for Prostate Surgeries procedure codes will be implemented. How this impacts providers: The following...

Provider Alert!

Provider Alert! Vision Services-Nonsurgical Benefits to Change

Date: August 25, 2021 Attention: Optometrists and Ophthalmologists Effective Date: September 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: Effective September 1, 2021, Texas Children’s Health Plan(TCHP) will implement the Vision Services benefit changes outlined in the TMHP Bulletin Vision Services-Nonsurgical Benefits to Change...

Provider Alert!

Provider Alert! Sleep Study Prior Authorization Update

Date: August 19, 2021 Attention: Primary Care Providers , Neurologists Effective Date: December 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: Effective December 1, 2021, Texas Children’s Health Plan will require a prior authorization for sleep studies for Members ages over 18 years old....

Provider Alert!

Provider Alert! New Procedure Codes Available for Evoked Response Tests and Neuromuscular 

Date: July 28, 2021 Attention: Audiologists, Radiologists, DME, and Lab Providers Effective Date: July 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: Beginning July 1, 2021, Healthcare Common Procedure Coding System (HCPCS) procedure codes 92652 and 92653 (for evoked response tests and neuromuscular), will...

Provider Alert!

Provider Alert! Therapy Prior Authorization Update

Date: July 29, 2021 Attention: All Providers Effective Date: August 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 providers of updated TCHP prior authorization requirements for therapy services. How this impacts providers: Requests for acute therapy...

Provider Alert!

Provider Alert! Annual Targeted Case Management and Mental Health Rehabilitative Services Training Attestation

Date: August 2, 2021 Attention: Mental Health Targeted Case Management and Mental Health Rehabilitative Services 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: This notice is to inform network Targeted Case Management Providers of their annual required training that is a contractual obligation. How this...

Provider Alert!

Provider Alert! Medicaid Preferred Drug List and Formulary Changes

Date: July 30, 2021 Attention: All Providers Effective Date: July 29, 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 Vendor Drug Program (VDP) implemented changes to the state Medicaid drug formulary, effective Thursday, July 29, 2021. Select medications moved from “preferred” to “non-preferred”...