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Provider Alert!

Provider Alert! Telemonitoring Benefits to Change for Texas Medicaid March 1, 2021

Date: March 24, 2021 Attention: All Providers Effective Date: March 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 (TCHP) would like to inform network providers of the recent telemonitoring benefits change for Texas Medicaid effective for dates of service on...

Provider Alert! Reminder – Updated- Approved in-office lab list

Date: September 9, 2021 Attention: All Providers Effective date for procedure code 83655, lead screening: June 22, 2021 Call to action: Texas Children’s Health Plan (TCHP) utilizes Quest Diagnostics as our exclusive reference lab provider. This alert is to serve as a reminder of the specific labs on our pre-approved list that may be run in a network provider’s office. How this impacts providers: Providers may perform specific lab tests in their office and receive reimbursement from TCHP. All other lab tests must be...

Provider Alert! COVID-19 Monoclonal Antibody Therapy Procedure Code Update

Date: July 19, 2021 Attention: All Providers Effective Date for Procedure code Q0244 is June 3, 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 inform network providers that Texas Medicaid has revoked the Emergency Use Authorization (EUA) of...

Provider Alert!

Provider Alert! Diabetes Awareness and Wellness Network (DAWN) Center

Date: March 18, 2021 Attention: Primary Care Providers and Endocrinologists 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) is happy to announce that we have partnered with the Diabetes Awareness and Wellness Network (DAWN) Center to serve as a viable...

Provider Alert!

Provider Alert! Prior Authorization Requirements for Incontinence Supplies

Date: March 15, 2021 Attention: All Providers Effective Date: December 22, 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) would like to inform network providers of the prior authorization requirements for incontinence supplies.   How this impacts providers: Incontinence supplies (diapers, wipes, and under pads) may be considered for members age 3...

Provider Alert!

Provider Alert! Prior Authorization Changes for Fasenra and Nucala

Date: February 19, 2021 Attention: Allergists & Immunologists, Pulmonologists Effective Date:  April 6, 2021 Call to action: Texas Children’s Health Plan (TCHP) is modifying prior authorization criteria for two monoclonal antibodies available through the pharmacy benefit: Fasenra (benralizumab) and Nucala (mepolizumab). Both are monoclonal antibodies approved for the treatment of severe asthma. The Texas Health and Human Services Commission (HHSC) revised the clinical prior authorization criteria for these agents to enhance appropriate utilization per the US Food and Drug Administration’s (FDA) approved indications and...

Provider Alert!

Provider Alert! Healthcare Common Procedure Coding System (HCPCS) update for Code 99201

Date: January 21, 2021 Attention: All Providers Effective Date: January 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 (TCHP) aligns with the guidance from Texas Medicaid Healthcare Partnership (TMHP) regarding HCPCS Code 99201. This code has been discontinued as a...

Provider Alert!

Provider Alert! Clinical Prior Authorization Updates for Cystic Fibrosis Agents

Date: February 25, 2021 Attention: Pulmonologists Effective Date: April 6, 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 April 6, 2021, the Texas Health and Human Services Commission (HHSC) will update the cystic fibrosis (CF) agents prior authorization criteria to reflect recent FDA-approved indication...

Provider Alert!

Provider Alert! Synagis Season Extended for Counties in Southeast Texas and Gulf Coast Areas

Date: February 26, 2021 Attention: All 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: Synagis (palivizumab) is indicated for children with a high risk of infection to respiratory syncytial virus (RSV).  This virus causes respiratory tract infections and severe lung disease in infants and...

Provider Alert!

Provider Alert! Viltepso Prior Authorization Update

Date: February 19, 2021 Attention: Neurologists Effective Date: March 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: Viltepso (viltolarsen) is a clinician-administered drug indicated for the treatment of Duchenne muscular dystrophy (DMD) amenable to exon 53 skipping. Viltepso will become available through Texas Medicaid...