Author - Texas Children's Health Plan
17Mar

Provider Alert! LARC Billing Update

Paragard and Nexplanon have been added to the Long-Acting Reversible Contraceptives (LARC) Buy Back Program. Paragard IUD (manufactured by Teva) and Nexplanon Implant (manufactured by Merck), have been added to the LARC Buy Back program, as the Mirena and Skyla currently are. Mirena and Skyla are currently available from Walgreens Specialty Pharmacy (NOTE: that has not changed from before). The Texas Medicaid/CHIP Vendor Drug Program has verified which pharmacies the Paragard IUD and Nexplanon Implants are available. In the case of Paragard: Biologics, Inc, Specialty...

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15Mar

Zika Virus and Pregnant Women

Everyone is talking about Zika! The virus is transmitted through infected mosquitos. Mexico, the Caribbean, Central America, along with parts of South America, have documented transmission of the virus and pregnant women who live in or travel to these areas are at risk of infection. Infection during pregnancy may or may not be accompanied by symptoms and has been associated with microcephaly. No treatment is available at this time. The most important thing to remember is that our knowledge about several...

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08Mar

Video: 2015-2016 Respiratory Virus Season Update

Dr. James Dunn, Medical Director for Medical Microbiology and Virology at Texas Children's Hospital provides an update on the 2015-2016 Respiratory Virus Season in Texas. Topics include an update on the current flu and RSV conditions in Texas, Point of Care (POC) testing, and helpful resources to help you through this year's Respiratory Virus Season.

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05Mar

Mosquitoes: Safe repellant and protection

By: Dr. Lia C. Rodriguez, MD FAAP Medical Director, Texas Children’s Health Plan The recent Zika virus epidemic has increased awareness of mosquito born illnesses. Currently, the biggest risk of infection with Zika is for women who are pregnant or considering pregnancy and their partners. Nevertheless, mosquitos can also carry other illnesses and create discomfort. There are several ways we can advise families to protect themselves and their children from mosquito bites. Advising environmental control is one important way. Mosquitos breed in standing...

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01Mar

It’s not too late to vaccinate!

The influenza season is underway, and flu activity is increasing in the US according to the latest CDC reports. Most reports of severe illness are in unvaccinated patients, therefore vaccination continues to be critical to provide protection against infection. Laboratory data confirms that the influenza viruses circulating in our communities match the strains in the 2015-2016 influenza vaccines. It is NOT too late to vaccinate our patients as antibodies only take about 2 weeks to develop for protection against the...

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15Feb

Prevent Behavioral Health Readmissions

Prevent Behavioral Health Readmissions Poor access to prescribed medications after discharge is one of the most common reasons for behavioral health readmissions. One effective way to help ensure access to medications post-discharge is to obtain and verify prior authorization for the medications before discharge. Texas Children’s Health Plan follows the state of Texas Medicaid Guidelines for the use and approval of antipsychotics in children. Criteria for approval can be accessed here. If a patient does not meet criteria and the prior authorization...

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21Jan

Provider Alert! Authorization requirement for non-emergent ambulance transfer

To: All providers Subject: Authorization requirement for non-emergent ambulance transfer Effective: April 1, 2016 Texas Children’s Health Plan members who require the use of an ambulance for non-emergent transport must have the request for authorization submitted by the member’s physician, facility or health-care provider. The request will be reviewed to determine if alternate means of transportation can be utilized for transport to a scheduled medical appointment or to and from a treating facility. Texas Children’s Health Plan does not accept authorization requests from ambulance/medical...

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21Jan

Provider Alert! Annual Reminder on Copayments and Deductibles

To:  All Texas Children’s Health Plan Providers Subject: Annual Reminder on Copayments and Deductibles Texas Children’s Health Plan will pay for a primary insurance deductible with proof of assignment to the deductible on the primary evidence of procedure. Payments will be made up to Medicaid allowable only. Claims for primary insurance copayments should be sent to Texas Medicaid and Healthcare Partnership directly.  Texas Children’s Health Plan will not pay CP001 or CP002 on a claim as these are not payable by the managed...

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12Jan

The Importance of Educating Patient’s Caregivers on Shaken Baby Syndrome

Shaken baby syndrome, or inflicted traumatic brain injury, is caused by the violent shaking of a child with or without contact between the child’s head and a hard surface. Such contact may result in head trauma, including subdural hematoma, diffuse axonal injury and retinal hemorrhage.  Shaken baby syndrome, is the most common cause of traumatic death for children younger than 1 year. Approximately 20 per 100,000 infants per year experience abusive head injuries resulting from shaking typically triggered by a...

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23Dec

Provider Alert! Billing Update for Texas Health Steps

To: All Texas Health Steps Providers Subject: Reminder – Billing for Texas Health Steps Services to Texas Children’s Health Plan Texas Children’s Health Plan follows the State of Texas Medicaid guidelines for Texas Health Steps checkups including the following: “Texas Health Steps medical checkups reflect the federal and state requirements for a preventive checkup. Preventive care medical checkups are a benefit of the Texas Health Steps program if they are provided by enrolled Texas Health Steps providers and all of the required components...

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