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Provider Alert!
05Mar

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...

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Provider Alert!
01Mar

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...

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Provider Alert!
01Mar

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...

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Provider Alert!
26Feb

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...

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Provider Alert!
23Feb

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...

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Provider Alert!
23Feb

Provider Alert! FMSA Cost Survey

Date: March 15, 2021 Attention: Financial Management Services Agencies (FMSA) Due Date: Training Webinar: March 19, 2021 & Cost Survey: Due April 19, 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 make FMSAs aware of a cost survey with a...

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Provider Alert!
23Feb

Provider Alert! 2021 Texas Brain Injury Conference and Virtual Webinar Series

Date: February 19, 2021 Attention: Relevant 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) extends an invite to network providers for the 2021 Texas Brain Injury Conference and Webinar Series sponsored by the Texas Brain Injury Programs at the...

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Provider Alert!
22Feb

Provider Alert! Changes to Hepatitis C Drug Coverage and Prior Authorization

Date: February 16, 2021 Attention: Gastroenterologists and Hepatologists 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: HHSC requires managed care organizations (MCOs) to follow the same Hepatitis C virus clinical prior authorization criteria guidelines as Texas Medicaid for treating clients who...

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Provider Alert!
22Feb

Provider Alert! Macrolides Clinical Prior Authorization Update

Date: February 19, 2021 Attention: Primary Care Providers Effective Date: March 15, 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 that beginning March 15, 2021 Texas Medicaid will change the preferred drug list (PDL)...

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Provider Alert!
22Feb

Provider Alert! Zika Prevention:  Mosquito Repellant Benefit Update

Date: February 10, 2021 Attention: Primary Care Providers Effective Date: February 18, 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 that effective February 18, 2021 Texas Medicaid will renew a standing order for select...

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