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Provider Alert!

Provider Alert! Drugs Added to Medicaid, CHIP Formularies on June 6, 2024

Date: June 18, 2024 Attention: All Providers Effective date: June 6, 2024 Call to action: Texas Children’s Health Plan would like to inform providers that the Vendor Drug Program added the new drugs to the table available below, effective June 6, 2024. National Drug CodeDrug NamePDL Status62135099260ZIPRASIDONE HCL 40 MG CAPSULEPDL (preferred)62135099160ZIPRASIDONE HCL 20 MG CAPSULEPDL (preferred)62135099360ZIPRASIDONE HCL 60 MG CAPSULEPDL (preferred)62135099460ZIPRASIDONE HCL 80 MG CAPSULEPDL (preferred)62135004190FOSINOPRIL SODIUM 10 MG TABPDL (preferred)69097099205DILTIAZEM 24H ER(LA) 120 MG TBNPD (non-preferred)69097099305DILTIAZEM 24H ER(LA) 180 MG TBNPD (non-preferred)69097099405DILTIAZEM...

Provider Alert!

Provider Alert! You’re Invited to Our Provider Advisory Group!

Date: June 18, 2024 Attention: All Providers Event dates for the upcoming sessions Tuesday, September 24, 2024Tuesday, December 10, 2024All sessions will be from 12:00-1:30PM CST Call to action: Texas Children’s Health Plan (TCHP) invites you to join our quarterly Provider Advisory Group (PAG). We will hold our next session in September. We have updated the organization of the sessions. We will now hold one for all three Service Delivery Areas combined each quarter. Sessions will be held online as a Microsoft Teams...

Provider Alert!

Provider Alert! Texas Children’s Health Plan Highlights Patient Communication

Date: June 17, 2024 Attention: All Providers Call to action: Texas Children’s Health Plan (TCHP) would like to highlight the topic of patient communication this month with our providers. One aspect of patient communication, Motivational Interviewing, has been known to aid in promoting healthy habits and optimizing self-care. “Health coaching, its origin from motivational interviewing, enhances patient self-management of chronic conditions by improving patient compliance and outcomes, and reducing costs.” Source: https://pubmed.ncbi.nlm.nih.gov/19745624/ Background information: Based on the 2023 Experience of Care and Health...

Provider Alert!

Provider Alert! Reminder about EVV Home Phone Landline Requirements

Date: June 14, 2024 Attention: STAR Kids Providers/Consumer Directed Services employers, and FMSA Providers Call to action: Texas Children’s Health Plan would like to remind program providers, financial management services agencies (FMSAs), and Consumer Direct Services (CDS) employers about the Electronic Visit Verification (EVV) home phone landline requirements. The EVV Home Phone Landline Requirements policy requires the use of an approved allowable phone type when a program provider has selected the member’s home phone landline as the clock in and clock out...

Provider Alert!

Provider Alert! Maximum Allowable Update for Non-Risk Based Drugs Billed With ‘Unclassified’ Procedure Codes

Date: June 12, 2024 Attention: All Providers Call to action: The Texas Health and Human Services Commission (HHSC) would like to disclose the maximum allowable reimbursement for Non-Risk drugs currently payable under an ‘Unclassified’ procedure code as referenced in the National Drug Code to Healthcare Common Procedure Coding System (NDC to HCPCS) crosswalk. How this impacts providers: HHSC bases the pricing for an outpatient medical claim for an ‘Unclassified’ procedure code on the lesser of the manufacturer’s suggested retail price minus 18% or...

Provider Alert!

Provider Alert! Updates for Bone-Anchored Hearing Device (BAHD) Procedure Codes 92622 and 92623 for Texas Medicaid

Date: June 12, 2024 Attention: All Providers Effective Date: July 1, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that on July 1, 2024, the Texas Medicaid & Healthcare Partnership (TMHP) will update the Texas Medicaid Provider Procedures Manual (TMPPM), Vision and Hearing Services Handbook to move diagnostic analysis procedure codes 92622 and 92623 from section 3.2.1, “Cochlear Implants,” to section 3.2.3, “Bone-Anchored Hearing Device (BAHD).” Procedure codes 92622 and 92623 may be reimbursed for diagnostic analysis of the cochlear implant. Claims...

Provider Alert!

Provider Alert! Calendar Year 2024 EVV Proprietary System Request Form Submission Deadline July 15, 2024

Date: June 6, 2024 Attention: STAR Kids Providers/Consumer Directed Services employers, and FMSA Providers Call to action: Texas Children’s Health Plan would like to share that Texas Health and Human Services Commission (HHSC) is notifying program providers and financial management services agencies (FMSAs) who are interested in the opportunity to participate and complete the Proprietary System Operator (PSO) Onboarding process this calendar year (2024) that they must submit a Proprietary System (PS) Request Form by July 15, 2024. The PS Request Form can be...

Provider Alert!

Provider Alert! Update to Age Requirement for Prior Authorization of Inotuzumab Ozogamicin (Besponsa)

Date: June 6, 2024 Attention: All Providers Effective for dates of service on or after: July 1, 2024 Call to action: The purpose of this communication is to inform providers that effective for dates of service on or after July 1, 2024, the age requirement for prior authorization of inotuzumab ozogamicin (Besponsa) (procedure code J9229) will be expanded to include pediatric and adult clients who are one year of age or older. How this impacts providers: Providers should reference the current Texas Medicaid Provider...

Provider Alert!

Provider Alert! Notification of Hospital Emergency Room (ER) Reimbursement Policy

Date: June 3, 2024 Attention: All Providers Effective Date: September 1, 2024 Call to action: The purpose of this communication is to make providers aware of a new reimbursement policy for Texas Children’s Health Plan (TCHP), which outlines and standardizes reimbursement for emergency room (ER) services.  This policy is for general acute care hospitals that do not have emergency room services defined in their contract. This applies to CHIP and Medicaid lines of business. How this impacts providers: Policy guidelines are as follows: ER services (upper...

Provider Alert!

Provider Alert! Updated National Drug Codes Added to Medicaid, CHIP Formularies

Date: May 31, 2024 Attention: Providers Effective date: May 8 and May 10, and May 16, 2024 Call to action: Texas Children’s Health Plan would like to inform providers that the Vendor Drug Program added the new drugs to the table available below, effective May 8, 2024, May 10, and May 16, 2024. National Drug CodeDrug NameEffective Date00173090442NUCALA 40 MG/0.4 ML SYRINGE5/8/202415370030560POKONZA 10 MEQ PACKET5/8/202464406003002ZURZUVAE 25 MG CAPSULE5/10/202464406003101ZURZUVAE 30 MG CAPSULE5/10/202468682013350CLINDAMYC-BNZ PEROX 1.2-3.75/10/202472786010202OXBRYTA 300 MG TABLET5/10/202472786010203OXBRYTA 300 MG TABLET5/10/202472205018138PIRFENIDONE 267 MG TABLET5/10/202459651020623NITROFURANTOIN 25 MG/5...