News Blog

Provider Alert!
16Oct

Provider Alert! Dental Varnish Services

Date: October 16, 2019 Attention: Primary Care Providers Subject: Dental Varnish Services Call to action: Texas Children’s Health Plan (TCHP) identified an error in the reimbursement of dental varnish services.  This error may have resulted in non-payment of this service during a medical checkup for TCHP members who are 6 to 35 months of age.  An update to TCHP’s claims payment system is currently in process and all impacted claims will be reviewed and reprocessed for payment within the next 30 days. How this...

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Provider Alert!
16Oct

Provider Alert! Reimbursement Rate Changes for PCS, PDN & Therapy Services

Date: October 16, 2019 Attention: Home Health, Therapy and LTSS Providers Subject: Reimbursement Rate Changes for PCS, PDN & Therapy Services Effective Date: September 1, 2019 Call to action: On August 28, 2019, Texas Children’s Health Plan (TCHP) received notice of the rate changes from Texas Medicaid Healthcare Partnership (TMHP) effective September 1, 2019.  The services impacted by the Medicaid-implemented rate changes include: Personal Care Services (PCS) Private Duty Nursing (PDN) Therapies for Children in the Home Therapy Assistants TCHP is in the process of implementing the updates in...

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12Oct

Flu protection starts now

Influenza vaccines are available free-of-charge to enrolled providers through the Texas Vaccines for Children (TVFC) program for STAR, STAR Kids, and CHIP members birth through 18 years of age. Remind your Texas Children’s Health Plan patients that the influenza vaccine is a covered benefit. Texas Children’s Health Plan members who are age 7 years and older can also receive the influenza vaccine at a participating pharmacy. Click here for a list of pharmacies.

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Inovalon
07Oct

Understand your patients’ care gaps and improve your quality of care with the Inovalon HEDIS® Metrics Tool

Texas Children’s Health Plan PCPs and OB/GYN providers can now access data via the Inovalon HEDIS Metrics Tool through our Provider Portal. This new tool allows you to use performance and patient data so that you can independently manage your patient population, as well as improve the quality of disease management throughout your panel. Key features such as member-level gap reports and detailed HEDIS quality rates contribute to improving your provider incentive program rates. If you have any questions about Inovalon...

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Provider Alert!
07Oct

Provider Alert! Correction for new claim requirement

Effective October 1, 2019, all claims submitted to Texas Children’s Health Plan must be submitted with the member’s state provided Medicaid Identification Number and date of birth on the claim. Providers should confirm the Medicaid Identification Number is submitted in block {1a} for CMS-1500 forms and block {60} of a CMS 1450 (UB-04). For electronic claims, the member Medicaid Identification Number should be submitted in Loop 2010BA for either the 837P or 837I.The member’s date of birth must also be included. Claims...

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Provider Alert!
01Oct

Provider Alert! Physician services provided in outpatient hospital settings

Effective October 1, 2019, physician services furnished in outpatient hospital settings that are ordinarily provided in a physician office will be reimbursed at a rate of 60% of the Texas Medicaid rate as outlined in Section 9.5.3 Reimbursement of the Texas Medicaid Provider Procedures Manual (TMPPM). Providers should verify impacted procedures and Place of Service (POS) codes to determine appropriate payment for covered services. The applicable procedure codes for those services include, but are not limited to: 99201-99205, 99211-99215, and 99281-99283. Next...

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Provider Alert!
01Oct

Provider Alert! DME/equipment/supplies exceeding Texas Medicaid Limitations

Effective October 1, 2019, Texas Children’s Health Plan will implement a prior authorization process for providers to request prior approval to provide DME/Equipment/Supplies to members 20 years of age and under in excess of benefit limitations. Texas Children’s Health Plan applies benefit limitations for DME/Equipment/Supplies in accordance with the Texas Medicaid Provider Procedure Manual (TMPPM) for all members eligible to receive the benefit, except for the following:   Next steps for providers: DME/Equipment/Supplies for a member who is 20 years of age or younger...

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27Sep

Appointment Availability Standards for Specialty Care and Behavioral Health

What are appointment availability standards? How do you as a provider with Texas Children’s Health Plan play a role? In 2015 Senate Bill 760 passed, requiring Texas Health and Human Services Commission (HHSC) to monitor the provider networks of managed care organizations. Texas Children’s Health Plan would like to ensure members are able to schedule appointments with providers in accordance with the HHSC’s appointment accessibility guidelines.   PLEASE NOTE: Specialist visits do not require primary care provider (PCP) referral.

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Provider Alert!
26Sep

Provider Alert! Information for Members on Recent Storm

Dear Providers, The services you provide to our members are important and during this time of inclement weather, we want to make accessing health care as easy as possible. Please find important details to assist you below.  This information only applies to members located in the impacted counties as outlined. Impacted Counties:  Brazoria, Chambers, Galveston, Hardin, Harris, Jasper, Jefferson, Liberty, Matagorda, Montgomery, Newton, Orange, and San Jacinto Important Things to Know: Prior authorizations are waived for medically necessary procedures and treatments including service provided...

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Provider Alert!
26Sep

Provider Alert! Initial specialty therapy evaluations no longer require an authorization but do require current Texas Health Steps checkup or attestation

Date: September 19, 2019 Attention: All Providers Subject:  Amended:  Initial and Ongoing Specialty Therapy Treatment- Current Texas Health Steps Checkup or Attestation required Effective Date: September 19, 2019 Call to action: Initial specialty therapy (occupational, physical, speech therapy) evaluations do not require prior authorization effective September 1, 2019. However, a current Texas Health Steps checkup performed in the last 12 months or a current well checkup attestation is required for ongoing specialty therapy lasting for greater than 60 days. How this impacts...

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