News Blog

Provider Alert! STAR Kids Billing Requirements

Attention: STAR Kids Providers REMINDER: STAR Kids Billing Requirements   As previously communicated, Texas Children’s Health Plan (TCHP) requires all STAR Kids providers billing for private duty nursing (PDN) services with the T1000 CPT code to use the billing matrix available on the Texas Health and Human Services website at https://hhs.texas.gov/laws-regulations/handbooks/star-kids-handbook/appendices/appendix-iii-ltss-billing-matrix-crosswalk. This requirement was effective June 5, 2017.   Failure to use this billing matrix, including placement of modifiers, will result in denials for incorrectly billed services.  Providers may receive line denials if [...]

Improving Postpartum Hospital Discharge Education

In September 2018, the Texas Maternal Mortality and Morbidity Task Force released its latest report on deaths occurring during pregnancy and up to 1 year following the end of pregnancy.  Approximately 20% of maternal deaths occurred while the mother was pregnant or during the first 7 days after delivery!  Detailed maternal death case reviews revealed that “inadequate knowledge and lack of early recognition of postpartum complication signs frequently contributed to death.”1 Recommendations by the Task Force included that improvements be [...]

Provider Alert! Reminder – LTSS Enrollment Deadline Extended to October 31, 2018

Attention:  Long Term Services and Supports Providers (LTSS) Subject:  Reminder - Enrollment Deadline Extended to October 31, 2018   This is a reminder that the enrollment deadline for Long Term Support Services (LTSS) providers serving MCO members is quickly approaching. Long Term Support Services (LTSS) providers serving MCO members are required to enroll through the Medicaid MCO LTSS provider enrollment process.   To allow sufficient time for application processing, MCO LTSS providers are strongly advised to submit applications as soon as possible.   An MCO LTSS [...]

Updating Texas Children’s Health Plan Member Change of Address Information

All address changes must be reported to HHSC. Members can contact HHSC by calling 2-1-1 or by updating their account on YourTexasBenefits.com. It is important to make sure address information is updated in a timely manner to ensure families continue to receive information from Texas Children’s Health Plan and HHSC. If a member has moved to an area that is not covered by Texas Children’s Health Plan, they will need to select a new health plan. If a family [...]

Provider Alert! Texas Children’s Health Plan Claim Editing System Update

Attention:  All Providers Subject: Texas Children’s Health Plan Claim Editing System Update Effective: 12/27/2018   Texas Children’s Health Plan intends to transition to a new Claims Editing System (CES) by Optum on 12/27/2018. Please be aware that claims submitted prior to 12/27/2018 will continue to be processed by our current vendor, McKesson Claim Check. TCHP is required by Texas Health and Human Services to ensure all required claims edits are consistently applied. Migrating to Optum CES will enable TCHP to efficiently apply all required [...]

Provider Alert! Neonatal Level of Care Designation Updates

Date: August 28, 2018 Attention:  All Hospitals  Subject:  Neonatal Level of Care Designation Updates Effective for dates of service on or after September 1, 2018, hospitals enrolled in Texas Medicaid may be reimbursed for inpatient neonatal services only if the hospitals have received a neonatal level of care designation from the Department of State Health Services (DSHS) in accordance with 25 Texas Administrative Code §§133.181-133.190. Requirements: Hospitals with neonatal units must have a level of care designation.  Information on these requirements and an application [...]

Breaking Reminder: Syphilis Screening Urged for All Pregnant Women

The number of congenital syphilis cases is rising at an alarming rate.  From 2012-2016 the rate of congenital syphilis increased by 87% (from 8.4 to 15.7 cases per 100,000 live births).1   According to historical data, up to 40% of pregnancies with untreated syphilis will result in miscarriage, stillbirth, or infant death.  And those infants who live are at risk for skeletal abnormalities; hepatosplenomegaly; jaundice; anemia; and other complications which can cause developmental delays and seizures.2   Given that congenital syphilis [...]

Telemedicine and Telehealth Webinar

On October 26, 2018, TMHP will host a live webinar to present a high-level overview of Telemedicine and Telehealth services and resources available to providers. Topics covered in the webinar will include: Reimbursements Places of service Provider Types Procedure codes and modifiers Documentation requirements Resources The Telemedicine and Telehealth Services webinar will introduce providers to information and reference materials that can improve their experience with Medicaid. Follow the link below to register: https://register.gotowebinar.com/register/8794348491023185667 After registering, a confirmation email will be sent with information about joining the webinar.  For more information, [...]

Texas Children’s Health Plan Provider and Member Portals

As a Texas Children’s Health Plan provider, you have access to the Texas Children’s Health Plan provider portal, called TouCHPoint. This portal can be used to check member eligibility, benefits, primary care provider selection, and claims status. To access Provider TouCHPoint, just log on to TexasChildrensHealthPlan.org/for-providers and find the TouCHPoint log-in on the right-hand side of the web page. Texas Children’s Health Plan members can access their own portal at TexasChildrensHealthPlan.org/for-members. The Member Portal allows your patients to play an [...]

October 11 is National Depression Screening Day

National Depression Screening Day is held annually in October. Depression is the leading cause of disability in the U.S. for ages 15-44. It is estimated that up to 64% of youth with major depressive disorder do not receive mental health treatment. Depression in youth has been linked to school and behavioral problems, self-injury and suicide, and poor social functioning. The incidence of perinatal depression ranges from 5 to 25 percent of pregnant and postpartum women, and studies of low-income [...]