News Blog – Page 20 – The Checkup

09MayMay 9, 2023

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...

By Texas Children's Health PlanSpecialistsbilling matrix, Crosswalk, LTSS, STAR Kids0 CommentsRead more...

09MayMay 9, 2023

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,...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, SpecialistsHCPCS, Prior Authorization, Unclassified Medical Drugs, VDP, Vendor Drug Program0 CommentsRead more...

08MayMay 8, 2023

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...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialistsaccessibility, Appointments, Survey0 CommentsRead more...

08MayMay 8, 2023

Provider Alert! Monovalent Moderna and Pfizer-BioNTech COVID-19 Vaccines Removed From Formulary on April 21, 2023

Date: May 8, 2023 Attention: All Providers Effective Date: April 21, 2023 Call to action: Texas Children Health Plan (TCHP) would like to inform providers that effective April 21, 2023, the U.S. Food and Drug Administration (FDA) amended the emergency use authorizations of the Moderna and Pfizer-BioNTech COVID-19 bivalent mRNA vaccines. This is to simplify the vaccination schedule for most individual vaccines, and monovalent are no longer authorized for use in the United States. This announcement includes authorizing the current bivalent vaccines (original and...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, SpecialistsCOVID, COVID-19, FDA, Formulary, Removal, vaccines0 CommentsRead more...

04MayMay 4, 2023

Provider Alert! Quantity Limit Change for Direct Antivirals Scheduled for May 25, 2023

Date: May 4, 2023 Attention: All Providers Effective Date: May 25, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective May 25, 2023, the Health and Human Services Commission (HHSC) is implementing new policies to improve access and adherence to direct antivirals. Providers will now be able to write prescriptions for the entire course of therapy for the direct antivirals, eliminating the need for additional refills. How this impacts providers: Starting May 25, 2023, due to...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialistsantiviral, hhsc, Mavyret, METAVIR0 CommentsRead more...

02MayMay 2, 2023

Provider Alert! Provider Enrollment Revalidation Extensions to End on May 11, 2023

Date: May 2, 2023 Attention: All Providers Call to action: Texas Children’s Health Plan would like to remind providers that effective May 11, 2023, the Health and Human Services Commission (HHSC) will end the flexibility of extended Medicaid provider revalidation dates that came due during the COVID-19 public health emergency (PHE). Additional information: Per federal guidance, providers that were due for revalidation effective March 1, 2020, through May 11, 2023, will receive a post-PHPHE grace period to complete the revalidation process. Texas Medicaid and...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, SpecialistsExtensions, PHE, Provider Enrollment, public health emergency, revalidation0 CommentsRead more...

28AprApril 28, 2023

Provider Alert! Non-Formulary Requests for Obesity Control Drugs

Date: April 28, 2023 Attention: All Providers Effective Date: March 1, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective March 1, 2023, the Health and Human Services Commission (HHSC) will no longer approve medically necessary non-formulary drug requests for obesity control drugs for individuals 21 years and older. This aligns with the Social Security Act, Section 1905, since coverage of these drugs is not included in the Medicaid State Plan. The drugs excluded from...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, SpecialistsDrugs, non-formulary, obesity, Pharmacy0 CommentsRead more...

28AprApril 28, 2023

Provider Alert! New Audit Programs Vendor EXL

Date: April 27, 2023 Attention: All Providers Effective Date: April 26, 2023 Call to action: Texas Children’s Health Plan (TCHP) Controls and Compliance (CC) would like to let providers know that TCHP has contracted with an external auditor, ExlService.com (EXL) to support its upcoming audit efforts. For your awareness, TCHP’s CC is organized within the Office of General Counsel under the Controls and Compliance Department. EXL is currently conducting audits, and will introduce the following new audit programs starting April 26, 2023: High Cost Drug...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, SpecialistsAudit, Controls and Compliance, DME, Drug Cost, Outpatient0 CommentsRead more...

27AprApril 27, 2023

Provider Alert! UPDATE: Provider Enrollment and Management System (PEMS) Provider Guidance

Date: April 27, 2023 Attention: All Providers NEW Effective Date: June 30, 2023 Important provider notice: As a reminder, the Provider Enrollment and Management System (PEMS) is the required Texas Medicaid & Healthcare Partnership (TMHP) program which is the single tool for provider enrollment, reenrollment, revalidation, and maintenance requests (maintaining and updating provider enrollment record information) for Texas Medicaid. Accordingly, as an MCO, TCHP will contract, credential and pay only those providers who are properly enrolled with TMHP and whose information is received in...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialistsguidance, Management system, PEMS, Provider Enrollment, tmhp0 CommentsRead more...

25AprApril 25, 2023

Provider Alert! Clinical Criteria Revision for Cibinqo Effective May 31, 2023

Date: April 25, 2023 Attention: All Providers Effective Date: May 31, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective May 31, 2023, the Health and Human Services Commission (HHSC) will expand coverage for Cibinqo to adolescents 12-18 years of age due to a recent U.S. Food and Drug Administration (FDA) approval. Cibinqo belongs to a class of medications called Janus Kinase (JAK) Inhibitors and is indicated for the treatment of adults with refractory moderate-to-severe atopic...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialistsatopic dermatitis, Cibinqo, JAK, Kinase (JAK) Inhibitors0 CommentsRead more...