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Provider Alert!
08Dec

Provider Alert! Dupixent (dupilumab) Criteria Update

Date: December 7, 2021 Attention: Primary Care Providers and Pulmonologists Subject: Dupixent (dupilumab) Criteria Update Effective Date: October 20, 2021 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event. Call to action: Effective October 20, 2021, Texas Medicaid revised criteria of the Dupixent (dupilumab).  Dupixent is FDA-approved as an add-on maintenance...

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Provider Alert!
08Dec

Provider Alert! Promethazine Update

Date: December 7, 2021 Attention: Primary Care Providers Effective Date: December 7, 2021 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event. Call to action: Texas Medicaid revised the Promethazine/Promethazine containing clinical prior authorization criteria by removing the Generic Code Numbers (GCN) for promethazine containing cough and cold products. Prior...

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Provider Alert!
08Dec

Provider Alert! Yescarta Prior Authorization Criteria Update

Date: December 7, 2021 Attention: Oncologists Effective Date: November 1, 2021 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event. Call to action: Texas Children’s Health Plan updated the clinical prior authorization criteria for Yescarta (procedure code Q2041) to align with the recent FDA indication expansion and guidance from the...

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Provider Alert!
29Nov

Provider Alert! Well Child and Texas Health Steps Visit reminder

Date: November 22, 2021 Attention: PCP, OB/GYN and Endocrinologist Providers Call to action: Texas Children’s Health Plan (TCHP) would like to remind you of the National Committee for Quality Assurance (NCQA) HEDIS Technical Specifications. How this impacts providers: Please submit all claims timely, as soon as services are rendered, and use appropriate codes to reflect the services provided particularly for Well-Care Visits and THSteps. Well-Child Visits in the First 30 Months of Life (W30) Two rates will be measured: Well-Child Visits in the First 15 Months: Six...

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24Nov

Provider Alert! Reimbursement Rate Updates for COVID-19 Pfizer Vaccine Administration Procedure Codes 0071A and 0072A

Date: November 22, 2021 Attention: All Providers, including pharmacists Effective Date: Dates of service on or after October 29, 2021 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event. Call to action: For dates of service on or after October 29, 2021, the reimbursement rates for COVID-19 Pfizer vaccine administration...

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24Nov

Provider Alert! Well Child and Texas Health Steps Visit reminder

Date: November 22, 2021 Attention: PCP, OB/GYN and Endocrinologist Providers Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event. Call to action: Texas Children’s Health Plan (TCHP) would like to remind you of the National Committee for Quality Assurance (NCQA) HEDIS Technical Specifications. How this impacts providers: Please submit all claims...

By OB/GYNs, Primary Care Providers, Provider Alert0 CommentsRead more...
Provider Alert!
19Nov

Provider Alert! Texas Medicaid and Healthcare Partnership (TMHP) Provider Enrollment and Management System (PEMS)

Date: November 29, 2021 Attention: All Providers Effective Date: December 13, 2021 for PEMS Webinar date: December 7, 2021 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event. Call to action: Texas Children’s Health Plan would like to remind providers that the Texas Medicaid & Healthcare Partnership’s (TMHP) Provider Enrollment and...

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Provider Alert!
18Nov

Provider Alert! JW Modifier Update

Date: November 18, 2021 Attention: All Providers Effective Date: September 1, 2020 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event. Call to action: Texas Children’s Health Plan (TCHP) aligns with Texas Medicaid and Healthcare Partnership (TMHP) regarding the reimbursement policy for the unused portion of a single use vial...

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17Nov

NEW Provider Scorecard – Empowering providers to maximize the impact of their services

NEW Provider Scorecard – Available for all Primary Care Physicians Texas Children’s Health Plan has created the Provider Scorecard to equip primary care physicians with metrics that will help maximize the value of their services while optimizing costs. The Provider Scorecard contains key information regarding Quality, Service and Cost metrics. By placing this data under one location, Texas Children’s Health Plan is giving PCPs the opportunity to take actionable steps towards a better outcome for them, the health plan, and our...

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Provider Alert!
15Nov

Provider Alert! Revised EVV Policy Handbook Now Available

Date: November 15, 2021 Attention: Financial Management Services Agencies (FMSA) and Consumer Directed Services (CDS) Employers Effective Date: November 1, 2021 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event. Call to action: Revisions to the Electronic Visit Verification Policy Handbook published Nov. 1. The handbook includes EVV standards and...

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