News Blog – Page 17 – The Checkup

25JulJuly 25, 2023

Provider Alert! TexMedConnect and EVV Portal Access

Date: July 25, 2023 Attention: Home Health Care Services Providers, STAR Kids Providers/Consumer Directed Services employers and FMSA Providers Effective Date: January 1, 2024 Call to action: The Texas Health and Human Services Commission (HHSC) would like to let providers know that Electronic Visit Verification (EVV) will be required for Home Health Care Services (HHCS) as of January 1, 2024. The HHCS required to use EVV are found in the document, Programs, Services and Service Delivery Options Required to Use Electronic Visit Verification by January...

By Texas Children's Health PlanFacilities, Office Managers, Provider Alert, SpecialistsCDS, EVV, FMSA, Home Health Care, STAR Kids Providers, TexMedConnect0 CommentsRead more...

21JulJuly 21, 2023

Provider Alert! Medicaid Preferred Drug List and Formulary Changes

Date: July 21, 2023 Attention: All Providers Effective Date: July 27, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective July 27, 2023, select medication(s) moved from “preferred” to “non-preferred” status. A summary of the changes is included below. Resource: https://www.txvendordrug.com/formulary/preferred-drugs Changes with biggest impact to Texas Children Health Plan members and providers: The drugs listed below were either not previously reviewed (NR) and became non-preferred (NPD) or previously considered a preferred agent (PDL) but now have changed...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialistsformulary changes, medicaid, PDL, Preferred Drug List0 CommentsRead more...

21JulJuly 21, 2023

Provider Alert! EVV Proprietary System Operator Waitlist is Full

Date: July 20, 2023 Attention: STAR Kids Providers/Consumer Directed Services employers and FMSA Providers Call to action: The Texas Health and Human Services Commission (HHSC) is notifying all program providers and FMSAs that the waitlist to onboard as an EVV Proprietary System Operator (PSO) is full. Program providers or FMSAs on the waitlist as of Friday, June 23, 2023, will participate in the expedited PSO onboarding session planned between July 15 through Aug. 31. How this impacts providers: Program providers and FMSAs who...

By Texas Children's Health PlanFacilities, Primary Care Providers, Provider Alert, SpecialistsEVV, FMSA, Proprietary System Operator, PSO0 CommentsRead more...

19JulJuly 19, 2023

Provider Alert! 2024 Annual Hospitals Standard Dollar Amount Verification

Date: July 19, 2023 Attention: Non-Rural and Non-State-Owned Hospital Providers Due date for the SDA Add-on Status Verification Form, if required: July 24, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers about the 2024 Annual Hospitals Standard Dollar Amount Verification. Background information: In accordance with Texas Administrative Code (TAC), §355.8052(d)(9), related to Medicaid Inpatient Hospital Reimbursement, hospitals may receive an annual standard dollar amount (SDA) adjustment based upon their trauma and/or safety-net designation. If qualified, hospitals may also...

By Texas Children's Health PlanFacilitiesAnnual Hospitals Standard Dollar Amount, SDA, TAC, Verification0 CommentsRead more...

19JulJuly 19, 2023

Provider Alert! Prior Authorization Updates for Neurostimulators and Neuromuscular Stimulators

Date: July 18, 2023 Attention: All Providers Effective date: July 1, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers of a new prior authorization requirement effective July 1, 2023, for neurostimulators and transcutaneous electrical supply- CPT Code A4560. How this impacts providers: This prior authorization requirement aligns with the TMPPM and applies to all lines of business CHIP, STAR, and STAR Kids. There is a limit to one unit every 12 weeks or four units per year. Source: Texas...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, SpecialistsNeuromuscular Stimulators, Neurostimulators, Prior Authorization0 CommentsRead more...

19JulJuly 19, 2023

Provider Alert! Zynteglo® now a Medicaid and CHIP Benefit – Prior Authorization Effective September 1, 2023

Date: July 18, 2023 Attention: All Providers Effective Date: September 1, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective September 1, 2023, the Texas Health and Human Services (HHSC) will be implementing required prior authorization criteria for Zynteglo® (procedure code J3590) for Medicaid and CHIP. Zynteglo® became a benefit of Medicaid and CHIP on July 1, 2023. Zynteglo® (betibeglogene autotemcel) is an autologous stem cell-based gene-therapy indicated for treating adult and pediatric patients with...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, SpecialistsCHIP, gene therapy, medicaid, Prior Authorization, Zynteglo0 CommentsRead more...

17JulJuly 17, 2023

Provider Alert! Prenatal Dental Care Information

Date: July 13, 2023 Attention: Ob-Gyn Providers Call to action: Texas Children’s Health Plan (TCHP) would like to remind OB-Gyn providers about the availability of dental benefits for pregnant Medicaid members. The CDC and ACOG both recommend routine dental care during pregnancy, but TCHP has noted a limited number of pregnant women are familiar with dental benefits. Routine dental care during pregnancy is safe and can improve maternal oral health, decreasing future dental issues for the mother and improving oral health for...

By Texas Children's Health PlanOB/GYNsDental, gynecology, OB, OB / GYN0 CommentsRead more...

13JulJuly 13, 2023

Provider Alert! Reimbursement for COVID-19 Vaccines for FQHCs and RHCs Reminder

Date: July 13, 2023 Attention: FQHC and RHC Providers End date for vaccine procedure codes: May 12, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to remind FQHC and RHC providers of the guidance from Texas Medicaid and Healthcare Partnership (TMHP) on COVID-19 vaccine procedure codes. Effective for dates of service on or after May 12, 2023, claims submitted by federally qualified health centers (FQHCs) and rural health clinics (RHCs) for the administration of COVID-19 vaccines will no longer be...

By Texas Children's Health PlanPrimary Care Providers, Provider Alert, SpecialistsCOVID, COVID-19, End, FQHC, reimbursement, RHC, vaccine0 CommentsRead more...

13JulJuly 13, 2023

Provider Alert! No-cost sports and school physicals for CHIP and Medicaid patients

Date: July 13, 2023 Attention: Primary Care Providers, OB/GYNs, and Office Managers Call to action: It will soon be back-to-school season, which means your patients will need to complete their annual sports and school physicals. As part of the Healthy Rewards Program*, Texas Children’s’ Health Plan CHIP, STAR and STAR Kids members ages 5 to 19 years** can receive a no-cost sports and school physical. A Texas Health Steps or well-child visit within the last 12 months is required. Members should bring...

By Texas Children's Health PlanOB/GYNs, Office Managers, Primary Care Providers, Provider AlertCHIP, medicaid, School Physicals0 CommentsRead more...

13JulJuly 13, 2023

Provider Alert! Signature Updates to Home Health Prior Authorization Request Forms

Date: July 12, 2023 Attention: All Providers Effective date: July 1, 2023 Call to action: The purpose of this communication is to provide awareness that the signature requirements for Title XIX (Medicaid) Home Health Services have changed. Medicaid-enrolled physicians and allowed practitioners can now sign prior authorizations and order covered Medicaid Home Health Services, including skilled nursing, home health aide services, durable medical equipment and supplies, and adult physical and occupational therapy services. An allowed practitioner is a physician assistant (PA) or an advanced...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, SpecialistsHome Health Services, medicaid, Medicaid Services, Prior Authorization0 CommentsRead more...