Author - Texas Children's Health Plan

Provider Alert!
17Jun

Provider Alert! Additional Diagnosis Codes and Place of Service Added for Ravulizumab-cwvz (Ultomiris)

Attention: Hematologists, Gastroenterologists, Rheumatologists Effective Date: June, 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) would like to inform you that we align with Texas Medicaid Provider Procedure Manual (TMPPM) regarding the guidelines for ravulizumab-cwvz, (Ultomiris), procedure code J1303....

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Provider Alert!
16Jun

Provider Alert! Reminder: Appointment availability standards for Obstetric providers

Attention: Obstetric Care Providers Effective Date: June 16, 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) would like to remind our Obstetric Care providers of the appointment availability standards recognizing the importance of the adherence to the standards. Network...

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Provider Alert!
12Jun

Provider Alert! Positive Pressure Airway (PAP) device guideline

Attention: All Providers Effective Date: June 17, 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: TCHP would like to inform you of recent updates to the guidelines for home health, speech therapy, and positive pressure airway (PAP) devices. Updates include the following: Home health guideline:...

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12Jun

Consumer Directed Services Employers Survey

For Providers: Consumer Directed Services Employers Survey Dear Consumer Directed Services employers, This notice is to inform you of a survey the Health and Human Services Commission (HHSC) Rate Analysis Department will release beginning Monday, June 15, 2020 and last through Wednesday, July 15, 2020. Click here to Learn More Click here to see more important Notices for Providers.

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Provider Alert!
12Jun

Provider Alert! Updates to Behavioral Health Inpatient and Outpatient Testing Evaluations

Attention: Behavioral Health Providers and Inpatient Facilities Effective Date: January 1, 2019 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 1, 2019, the benefit criteria for psychological, neurobehavioral, and neuropsychological testing for inpatient behavioral health and outpatient mental health services has changed for...

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Provider Alert!
12Jun

Provider Alert! Updated reimbursement information for Inpatient Genetic Services

Attention: Geneticist Effective Date: May 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: TCHP would like to inform you of a recent update to the reimbursement information for inpatient genetic service codes 99254 and 99255. Effective for dates of service on or after...

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Provider Alert!
01Jun

Provider Alert! Prior authorizations for hospital beds reminder and new codes added

Attention: All Providers Effective date for new codes: August 26, 2020 Call to action: Texas Children’s Health Plan (TCHP) would like to remind you that the following hospital beds and accessories’ codes require prior authorization. This follows the guidance from the Texas Medicaid Provider Procedures Manual (TMPPM).   Code Description E 0184 Dry pressure mattress E0185 Gel or gel-like pressure pad for mattress, standard mattress length E0186 Air pressure mattress E0187 Water pressure mattress E0188 Synthetic sheepskin pad E0189 Lamb’s wool sheepskin pad, any size E0190 Positioning cushion/pillow/wedge, any shape or size E0193 Powered air flotation bed (low air loss therapy) E0194 Air...

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Provider Alert!
28May

Provider Alert! Adakveo Update

Attention: Hematologists Effective Date: May 26, 2020 Call to action: Adakveo, Injection, crizanlizumab - clinician administered drug HCPCS code C9053 is an at risk drug. Currently, there is no prior authorization required; however, beginning May 26, 2020 authorization guidelines will be in place. The required criteria to receive Adakveo include: HbSS (sickle cell) diagnosis Patients over the age of 16 years-old Patients that have experienced more than two vaso-occlusive crisis (VOC) events in the past 12-months How this impacts providers: Prescribers should adhere to the guidelines and acquire...

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Provider Alert!
28May

Provider Alert! Housing Choice Plan Survey

Attention: All Providers Effective Date: Survey open May 15, 2020 until June 15, 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: The Health and Human Services Commission’s (HHSC) Behavioral Health Advisory Committee has approved the development of a Housing Choice Plan for individuals with...

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28May

National Blood Pressure Awareness Month

Blood pressure is the pressure of blood pushing against the walls of your arteries. Hypertension, also known as high blood pressure, is the force of your blood against the walls of your blood vessels. Hypertension increases the risk for heart disease and stroke. Sponsored by the Centers for Disease Control and Prevention (CDC) and recognized by the National Heart, Lung and Blood Institute (NHLBI), National High Blood Pressure Awareness Month raises awareness about the impact of hypertension (healthinsight.org). High Blood Pressure...

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