News Blog

Provider Alert! Update: Reimbursement Code for Sports and Camp Physicals

As spring training and sports begin, it’s an ideal time to ensure that all members are receiving their Texas Health Steps check ups timely. Texas Children’s Health Plan wants to remind our pediatric providers about sports physicals as value-added services. Members aged 5 - 19 (STAR & CHIP), 5 – 20 (STAR Kids) who have had a Texas Health Steps check up in the last 12 months will be eligible for one annual sports and school physical delivered by their [...]

Physician Incentive Program (updated Jan. 2019)

Texas Children’s Health Plan is introducing its new Physician Incentive Program in an effort to align with state performance and quality measures. The new program focuses on rewarding physician groups for reducing Potentially Preventable Emergency Room Visits (PPV) as well as improving utilization of preventive care based on the Healthcare Effectiveness Data and Information Set (HEDIS) measures. More Information

Telemedicine support now available

Texas Children's Health Plan supports the delivery of telemedicine, telehealth and telemonitoring services to its members. Telemedicine and telehealth services should be provided in compliance with standards established by the respective licensing or certifying board of the professional providing the services. Telemedicine and telehealth services do not require authorization when provided by an in-network provider, except in the case of telemonitoring services. Of note, Texas Children’s Health Plan will not cover telemedicine or telehealth services that are provided through only synchronous [...]

Health risk warning: infant botulism and risk of honey pacifiers

In November 2018, the Texas Department of State Health services released a health alert regarding infant botulism and the use of honey pacifiers. Because honey can contain spores of Clostridium botulinum, which can produce a neurotoxin known to cause serious illness in infants, parents are advised not to feed it to children younger than 12 months old. Consumption of honey is widely recognized as a risk factor for infant botulism by healthcare and public health professionals. Cases of infant botulism [...]

Reminder: Tdap vaccine coverage for CHIP Perinatal members

The Tetanus, Diphtheria, and Acellular Pertussis (Tdap) vaccine is part of routine prenatal care and is a covered benefit for CHIP Perinatal members. Claims are being appropriately reimbursed for this service. This vaccine is recommended by the Centers for Disease Control and Prevention (CDC), American Academy of Pediatrics (AAP), and American College of Obstetricians and Gynecologists (ACOG) as part of routine prenatal care: CDC: https://www.cdc.gov/pertussis/pregnant/mom/get-vaccinated.html AAP: https://www.aap.org/en-us/about-the-aap/aap-press-room/pages/AAP-Updates-TDAP-Recommendations.aspx ACOG: https://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Update-on-Immunization-and-Pregnancy-Tetanus-Diphtheria-and-Pertussis-Vaccination Resources: Original Notice: https://hhs.texas.gov/about-hhs/communications-events/news/2017/12/reminder-chip-p-coverage-tdap-vaccine Contact: Shuchita.Madan@hhsc.state.tx.us

Texas Standard Prior Authorization Request Form compliance grace period has ended

Starting January 1, 2019, the 90-day grace period for compliance with the exclusive use of the Texas Standard Prior Authorization Request Form has ended. From this date forward, providers must use the Texas Standard Prior Authorization Request Form, which can be found at https://www.texaschildrenshealthplan.org/for-providers. Click on Downloadable Forms on the left-hand side, then click Standard Prior Authorization Form or Behavioral Health Authorization Form to download. As a reminder, the following essential information is required to start the authorization process: Member Name, [...]

Provider Alert! Prior Authorization Alert

Effective January 1, 2019, Texas Children’s Health Plan updated the prior authorization listing. Please note there are some key changes for providers. Removed from the list and will no longer require prior authorization: Baclofen Pump New to the list: Home Telemonitoring Updates: Ambulance (non-emergent transport) has been updated to Non-Emergency Ambulance Transport. Augmentative Communication Device has been updated to Augmentative Communication Device and Accessories. Chemotherapy non-FDA approved has been updated to Non-FDA approved medications. Cranial Molding Orthosis (Helmets) has been updated to Cranial Molding Orthosis. High cost (>$50,000) injectable in [...]

Help your patients keep their New Year’s resolutions in 2019!

Texas Children’s Health Plan offers two programs that can help your patients stick to their New Year’s resolutions well into 2019! The Keep Fit program is available to STAR and CHIP patients ages 10-18 with a BMI of 20+. This program helps kids learn fun, easy ways to stay active and make smart food choices. It offers health coaching, four health and fitness sessions, at-home workout materials, and a quarterly newsletter – all at no cost to the member’s family. [...]

What does Service Coordination mean for your STAR Kids patients?

As a provider, you may have questions regarding the role Service Coordination plays in the lives of our STAR Kids members. At Texas Children’s Health Plan, the goal of Service Coordination is to optimize health to ensure that the member’s tomorrow is better than his or her today. Service Coordination is a person-centered approach to care and each of our members is assigned an appropriately licensed Service Coordinator. In order for that to happen, our Service Coordinators are responsible [...]