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Provider Alert!
26Apr

Provider Alert! EVV Alternative Device Phase-Out Schedule for Public Comment – Due by May 15

Date: April 26, 2024 Attention: STAR Kids Providers/Consumer Directed Services employers, and FMSA Providers Effective Date: May 15, 2024 Call to action: Texas Children’s Health Plan would like to inform program providers, financial management services agencies (FMSAs), and Consumer Direct Services (CDS) employers the Texas Health and Human Services Commission (HHSC) will be phasing out the use of alternative devices as an approved method to clock in and clock out of the Electronic Visit Verification (EVV) system to improve the accuracy of EVV. The...

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Provider Alert!
26Apr

Provider Alert! Change in Preferred Drug List Status for Antihyperuricemics Drug Class

Date: April 25, 2024 Attention: All Providers Effective date: April 22, 2024 Call to action: Effective April 22, 2024, the Texas Health and Human Services (HHS) removed non-preferred status from brand name Mitigare products. This is in response to the discontinuation of the brand products Colcrys by the manufacturer. The preferred status of the brand name Colcrys will not change to allow any remaining stock to be used. How this impacts providers: The change will allow providers to prescribe the generic without requiring PDL prior...

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Provider Alert!
24Apr

Provider Alert! Empowering Practices: A Hands-On Workshop on LARC Care and Client-Centered Contraceptive Counseling

Date: April 24, 2024 Attention: Obstetric Care Providers Workshop date: Thursday, May 2, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers of an upcoming in-person long-acting reversible contraception (LARC) training opportunity for Houston-area obstetric care providers.  This event is sponsored by ASTHO’s Contraception Access Learning Community, in collaboration with Healthy Futures of Texas, Every Body Texas, University of Missouri-Kansas City School of Nursing and Health Studies, and the Texas Women’s Healthcare Coalition, is excited to invite you to...

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Provider Alert!
24Apr

Provider Alert! Annual CMS Drug Utilization Review (DUR) Survey

Date: April 24, 2024 Attention: Medicaid Providers Deadline to complete survey: April 30, 2024 Call to action: The purpose of the communication is to inform prescribers of changes to the annual CMS Drug Utilization Review (DUR) Survey. The survey contains a new, required section of responses related to the Texas Prescription Drug Monitoring Program (PDMP). This year's survey is for data material from Federal Fiscal Year (FFY) 2023 (Oct. 1, 2022, to Sept. 30, 2023). Link to survey: CMS DUR Annual Survey–Provider PDMP Survey How...

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Provider Alert!
23Apr

Provider Alert! Updates to the EVV Visit Maintenance Processes Hold for HHAeXchange System Users for Dates of Service Prior to Go-Live Date

Date: April 23, 2024 Attention: STAR Kids Providers/Consumer Directed Services employers, and FMSA Providers Effective Date: April 22, 2024 Call to action: Effective April 22, Electronic Visit Verification (EVV) program providers, financial management services agencies (FMSAs), and Consumer Direct Services (CDS) employers who use HHAeXchange as their EVV system may now perform visit maintenance processes for dates of service prior to their go-live date with HHAeXchange. For Proprietary System Operators (PSOs), the visit maintenance hold for dates of service prior to go-live with their...

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Provider Alert!
18Apr

Provider Alert! Clinical Criteria Implementation for Enzyme Replacement Hormonal Therapy Agents effective May 1, 2024

Date: April 18, 2024 Attention: All Providers Effective Date: May 1, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective May 1, 2024, the Texas Health and Human Services (HHSC) will implement clinical prior authorizations to Adzynma (procedure code C9167) and Pombiliti (procedure code J1203) to the Enzyme Replacement Therapy (ERT) policy. Prior Authorization Requirements  Apadamtase alfa (Adzynma), procedure code C9167 is indicated to treat the following:  Pediatric and adult clients for prophylactic or on-demand ERT for congenital...

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Provider Alert!
18Apr

Provider Alert! Early Childhood Intervention (ECI) and Telehealth Services are not required to Use EVV

Date: April 17, 2024 Attention: Early Childhood Intervention and Telehealth Service Providers Effective date: January 1, 2024 Call to action: The purpose of this communication is to inform applicable service providers that Early Childhood Intervention (ECI) and home health services delivered via Telehealth are not required to use EVV for dates of service on or after January 1, 2024. Background: The Cures Act required states to implement Electronic Visit Verification (EVV) for Medicaid home health care services (HHCS) by Jan. 1, 2023. However, in...

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Provider Alert!
15Apr

Provider Alert! EVV Program Providers and FMSAs: Register for HHAeXchange Town Hall Webinars April 25 and May 30

Date: April 12, 2024 Attention: STAR Kids Providers/Consumer Directed Services employers, and FMSA Providers Call to action: Texas Children’s Health Plan (TCHP) would like to let program providers and financial management services agencies (FMSAs) know about the upcoming Electronic Visit Verification (EVV) Town Hall Webinar on Thursday, April 25, and Tuesday, May 30 from 1–3 p.m. (Central time). Agenda Overview of the EVV Transition EVV System Enhancements Addressing Key Concerns and Frequently Asked Questions Support Resources Q&A Session Click here to register. Next step for Providers: Providers are encouraged to share this communication...

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Provider Alert!
12Apr

Provider Alert! EVV Home Health Care Services (HHCS) Service Bill Codes Table Update Version 2.1

Date: April 12, 2024 Attention: STAR Kids Providers/Consumer Directed Services employers, and FMSA Providers Call to action: Texas Children’s Health Plan (TCHP) would like to inform applicable providers that a new version of the electronic visit verification (EVV) Health and Human Services (HHCS) Bill Codes Table has posted. The table is on the EVV 21st Century Cures Act webpage in Excel and PDF formats. Background:Effective January 1, 2024, Electronic Visit Verification (EVV) is required for Medicaid home health care services (HHCS). Program providers and financial management services agencies (FMSAs)...

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Provider Alert!
04Apr

Provider Alert! New Prior Authorization Resource to Determine Dates of Service

Date: April 3, 2024 Attention: All Providers Call to action: The purpose of this communication is to inform providers of a new resource available from Texas Medicaid and Healthcare Partnership (TMHP) available at https://www.tmhp.com/topics/prior-authorization/pa-calculator.  It is included on the TMHP prior authorization webpage. Providers are encouraged to utilize this calculator to calculate the dates of service that must be applied to the prior authorization form/prior authorization request.  By accessing TMHP’s tool, providers will save time and avoid having to resubmit or correct authorizations...

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