News Blog

Know When to Prescribe an Antiviral

Vaccination Flu season is back and vaccinating continues to be the best way to protect ourselves and our patients against serious complications from the flu.[1] Patients should only receive the intramuscular vaccine; intranasal flu vaccine is not effective for the 2016-2017 flu season.1 Patients 17 and younger should be offered the flu vaccine during office visits, while those 18 years and older also have the option of receiving it at pharmacies. Treatment (Antiviral and Supportive) Patients who are high risk for complications [...]

Screening for Maternal Depression – Essential to Child Well Being

Effective January 1, 2017, Texas Children’s Health Plan will reimburse providers for maternal depression screening conducted at a well-child visit. Postpartum depression screening utilizing the Edinburgh Postnatal Depression Scale may be reimbursed up to 2 times per member ages 0-6 months, using CPT code 96161. Code 96161 is used to report the use of a standardized instrument to screen for health risks in the caregiver for the benefit of the patient. The reimbursement for this code will be based [...]

Provider Alert! Prior Authorization required on all Vendor Drug Program (VDP) identified medications

Attention: Star Kids Providers Subject: Reminder: Prior Authorization required on all Vendor Drug Program (VDP) identified medications Texas Children’s Health Plan requires prior authorization (PA) on certain medications per the VDP website prior to dispensing to members. To obtain a list of medications requiring prior authorization, visit the VDP website at: Providers can also view instructions on accessing and using the formulary at the Texas Children’s Health Plan website: Providers can submit PA documentation to Texas Children’s Health Plan’s pharmacy benefit manager, [...]

Provider Alert! Prior Authorization for Sleep Studies

Effective February 1, 2017 Texas Children's Health Plan will require prior authorization on all sleep studies in children ages 18 and under. Claims for services on or after February 1, 2017 will be denied if no authorization is present. Please contact Texas Children's Health Plan Provider Relations at 1-800-731-8527, or visit the Texas Children's Health Plan Provider portal at for a copy of the guidelines utilized to determine medical necessity for sleep studies in children.

HEDIS Spotlight: Prenatal / Postpartum Care

HEDIS stands for Healthcare Effectiveness Data and Information Set. It is a widely used set of performance measures by the nation’s health plans, and an essential tool in ensuring that our members are getting the best healthcare possible. It is extremely important that our providers understand the HEDIS® specifications and guidelines. In this section of The Checkup we will highlight different HEDIS metrics. We will provide a description of the measures, the correct billing codes to support services rendered [...]

Provider Alert! Reminder on ability to bank respite hours for MDCP members

Attention: All STAR Kids Providers February 1st 2017 Subject: Reminder on ability to bank respite hours for MDCP members Texas Children’s Health Plan would like to remind all STAR Kids providers who are providing respite care to members of the standards around respite care hours and how Texas Children’s Health Plan manages these hours. The information below is directly from HHSC and is the guidance Texas Children’s Health Plan follows for determining respite care. Please always contact either Texas Children’ Health [...]

Texas Children’s Health Plan rolls out STAR Kids program in Tyler

Texas Children’s Health Plan recently opened its newest location in Tyler to serve the STAR Kids population in the northeast service area. A ribbon cutting ceremony at the office’s 100 East Ferguson in Tyler marked the grand opening of the satellite office. “We’re very excited to have the chance to serve families and their children with disabilities in Tyler and across Northeast Texas,” said Gail Bean, Provider and Care Coordination Regional Director. “We believe our long legacy and commitment to [...]

HHSC Notice! THSteps Documentation Improvement

Dear Texas Health Steps Provider: CHARLES SMITH EXECUTIVE COMMISSIONER As a Texas Health Steps (THSteps) provider, you affect the lives of many young Texans, and the Health and Human Services Commission (HHSC) understands documenting the THSteps components of the checkup can be challenging. One federal and two state contracted reviews of medical records have shown that missing documentation is the largest factor and the primary cause of records being reviewed and money being recouped. HHSC would like to assist you in documenting [...]

Provider Alert! Effective Provider Alternate Addresses

Attention: all Texas Children’s Health Plan Providers Subject: Provider Alternate Addresses Medicaid enrolled providers must have all service locations reflected in their state enrollment record prior to Medical Transportation Program (MTP) authorizing transportation for a client to the provider’s location. If an alternate address is not listed within the provider’s file sent to MTP, authorization will be denied. This means that every address where a provider will perform services has to have an active attested TPI. If all service locations are not [...]