News Blog
16May

Provider Alert! COVID-19 Vaccine Administration Procedure Code 0174A Is Now a Benefit of Medicaid and CHIP

Date: May 16, 2023 Attention: All Providers Effective date: Dates of service on or after March 14, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective for dates of service on or after March 14, 2023, in accordance with the U.S. Food and Drug Administration’s amended Emergency Use Authorizations, COVID-19 vaccine administration procedure code 0174A for the administration of the Pfizer-BioNTech COVID-19 vaccine booster is now a benefit of Texas Medicaid and CHIP for individuals 6...

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16May

Provider Alert! Infection Control Supplies Procedure Code S8301 No Longer a Benefit

Date: May 16, 2023 Attention: All Providers Effective Date: May 12, 2023 Call to action: Texas Children Health Plan (TCHP) would like to inform providers that effective with the end of the federal public health emergency (PHE) on May 11, 2023, the Health and Human Services Commission (HHSC) will end multiple temporary flexibilities related to the COVID-19 pandemic. Providers should be aware that this change impacts coverage and reimbursement for procedure code S8301for infection control supplies. Effective for dates of service on or after May...

By Facilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialists, , , , 0 CommentsRead more...
15May

Provider Alert! End of COVID flexibilities: Provider Signatures for All Therapy Services and Hearing Screening for Speech Therapy

Date: May 15, 2023 Attention: All Providers Effective date: June 13, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to make providers aware of the end to some COVID flexibilities related to Utilization Management.  Background information: The Health and Human Services Commission (HHSC) received notice that the COVID-19 federal public health emergency (PHE) declared on January 31, 2020, will end on May 11, 2023. In response to the PHE, TCHP implemented additional flexibilities during this time that will come to an...

By Facilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialists, , , 0 CommentsRead more...
Provider Alert!
11May

Provider Alert! New EVV Vendor System HHAeXchange Launching October 1, 2023

Date: May 11, 2023 Attention: All Providers Effective Date: October 1, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that a new single state funded Electronic Visit Verification (EVV) vendor system, HHAeXchange, is launching October 1, 2023. On April 26, 2022, the Texas Health and Human Services Commission (HHSC) posted a solicitation for EVV System Management Services. Through a competitive selection process, HHSC has selected Accenture State Healthcare Services LLC. How this impacts providers: Accenture will continue to be known...

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Provider Alert!
11May

Provider Alert! Inactive National Provider Identifiers in National Plan and Provider Enumeration System to Trigger Disenrollment Action

Date: May 10, 2023 Attention: All Providers Effective date: April 27, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to make providers aware that Texas Medicaid and Healthcare Partnership (TMHP) has identified several National Provider Identifiers (NPI) as inactive in the National Plan and Provider Enumeration System (NPPES) and will be taking immediate disenrollment action which will result in a payment denial code (PDC) 64 added on to the provider record in the Master Provider File (MPF). Provider Requirements, verification and...

By Facilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialists, , , 0 CommentsRead more...
Provider Alert!
11May

Provider Alert! Implementation of Hereditary Angioedema (HAE) Agents Clinical Prior Authorization for Fee for Service Scheduled for April 11

Date: May 10, 2023 Attention: Providers Effective Date: April 11, 2023 Call to action: Effective April 11, 2023 Texas Health and Human Services Commission (HHSC) added Takhzyro generic code (GCN) 39478 to the drugs requiring Hereditary Angioedema (HAE) clinical prior authorization for clients enrolled in Medicaid Fee-For-Service. How this impacts providers: Prescribers will now have to submit a prior authorization for Takhzyro® for their Medicaid fee-for-service population. Next steps for providers: Prescribers should share this communication with their staff. Provider must submit documentation (such as...

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09May

Provider Alert! HHSC to End Telephone (Audio-only) Medical Services COVID-19 Guidance and Issue Temporary Guidance for Certain Audio-Only Services

Date: May 8, 2023 Attention: All Providers Effective date: May 12, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective May 11, 2023, Health and Human Services Commission (HHSC) will end the temporary flexibility that has been allowed for telephone (audio-only) medical (physician-delivered) E/M services. HHSC authorized providers to bill procedure codes 99201-99205 and 99211-99215 to receive reimbursement for telephone (audio-only) medical (physician-delivered) E/M services delivered from March 20, 2020, through May 11, 2023. Billing information: Providers should...

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Provider Alert!
09May

Provider Alert! Changes to the Long-Term Services and Supports Billing Matrix and Crosswalk

Date: May 8, 2023 Attention: STAR kids Providers Effective date: July 1, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to notify providers of an upcoming change for the STAR Kids billing matrix effective July 1, 2023 for the revenue code 661. Description of the change:  Currently, the billing matrix reflects revenue code 661 (hourly/quarterly) to be billed with HCPCS code S5151 (Out-of-Home Respite (Facility)). This is incorrect, as the unit should be billed as a per diem rate. Health and...

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Provider Alert!
09May

Provider Alert! Subject: Unclassified Medical Drugs Prior Authorization Requirement

Date: May 8, 2023 Attention: All Providers Effective Date: June 8, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective June 8 2023, medical claims under $5,000 submitted to TCHP with unclassified Healthcare Common Procedure Coding System (HCPCS) code J3490 will no longer require a pre-service (prior authorization) request as claims above this cost will be subject to clinical necessity review by the pharmacy team. This dollar limit does not apply to other unclassified codes J9999, J3590,...

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Provider Alert!
08May

Provider Alert! Provider Offices Are Eligible for Incentive with Completion of Appointment Accessibility Survey

Date: May 8, 2023 Attention: Primary Care and Specialist Providers Launch timeframe: Summer 2023 Call to action: Texas Children’s Health Plan (TCHP) is excited to launch our annual Provider Appointment Accessibility this summer- this time with a new feature. Providers that complete the survey will be entered into a gift card drawing*. Winning practices will be contacted at the conclusion of the survey. Background information: In 2015, Senate Bill 760 passed, requiring Texas Health and Human Services Commission (HHSC) to monitor the provider networks...

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