News Blog
07Aug

Appointment Availability Standards for Primary Care and OB

Appointment availability standards 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. AFTER HOURS: Primary Care Physicians who are accessible 24 hours a day, seven days...

By OB/GYNs, Office Managers, Primary Care Providers, Specialists0 CommentsRead more...
Provider Alert!
06Aug

Provider Alert! TMHP EVV Prospective Process

Attention: All TCHP STAR Kids LTSS Providers Requiring EVV Subject: TMHP EVV Prospective Process Effective Date:  Effective 9/01/2019, the Texas Health and Human Services Commission (HHSC) will implement their new EVV claims matching process. Claims with a date of service on 9/01/2019 or later will be required to be sent to the Texas Medicaid & Healthcare Partnership (TMHP) for claims matching. After this date, all claims submitted directly to Texas Children’s Health Plan with a date of service on 9/01/2019 or later...

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01Aug

Flu protection for two: the importance of the flu vaccine during pregnancy

Influenza vaccination is an essential element of pre-pregnancy, prenatal, and postpartum care because influenza can result in serious illness, including a higher chance of progressing to pneumonia, when it occurs during the antepartum or postpartum period. In addition to hospitalization, pregnant women with influenza are at increased risk of intensive care unit admission and adverse perinatal and neonatal outcomes. The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices and the American College of Obstetricians and Gynecologists recommend that...

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Provider Alert!
24Jul

Provider Alert! Mandatory HHSC Webinar Training

7/23/2019 Attention: Financial Management Services Agencies (FMSA) HHSC is providing a webinar training for financial management services agencies (FMSAs). All FMSAs currently contracted with MCOs or HHSC must attend this mandatory training. When: Monday, July 29th at 1:30 p.m. Where: Online webinar, Register here: https://register.gotowebinar.com/register/6419407779512242946 What to expect: Consumer Directed Services (CDS) updates and reminders EVV updates   NOTE: Go to https://support.logmeininc.com/gotomeeting/get-ready  to run a test of your computer’s connectivity if you have never attended a Webinar from your computer. You can run this test at any time prior to the date...

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14Jul

HEDIS Spotlight

HEDIS® (Healthcare Effectiveness Data and Information Set) is a widely used set of performance measures that ensures our members are getting the best health care possible. It is extremely important that our providers understand HEDIS® specifications and guidelines. This section highlights different HEDIS metrics in addition to providing descriptions of the measures, correct billing codes to support services rendered, and tips to direct you to corresponding resources and tools. MEASURE: FOLLOW-UP AFTER HOSPITALIZATION FOR MENTAL ILLNESS MEASURE DESCRIPTION: Members 6 years of...

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11Jul

Texas Children’s Health Plan increases yearly gastrostomy button (G-button) limits

A message from Dr. Katy Ostermaier, Medical Director of STAR Kids at Texas Children’s Health Plan Texas Children’s Health Plan is pleased to announce an increase in gastronomy button (G-button) limits per year. As of February 26, 2019, we now allow 6 G-buttons to be dispensed per year. Families who have children with G-buttons can have a hard time getting the supply of replacement G-buttons needed when they break. An active child may need to replace broken G-buttons often, but Texas Medicaid...

By Office Managers, Primary Care Providers, Specialists, 0 CommentsRead more...
Provider Alert!
02Jul

Provider Alert! TCHP Prior Authorization Requirements

Date:  July 1, 2019 Subject: TCHP Prior Authorization Requirements Effective October 1, 2019, TCHP has updated the prior authorization listing. Please note there are some key changes for providers.   Added:            Case by Case Added Services This category includes CPT/HCPCS codes that are listed as not payable in the TMHP fee schedule. Clinician Administered Drugs that Require Authorization Please refer to the Prior Authorization Reference Information document for specific codes that fall under this category. This document can be found at: https://www.texaschildrenshealthplan.org/for-providers/provider-resources   DME Repair (K0739)...

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16Jun

For STAR Kids providers: Updated ANE Reporting Process

This requirement is effective September 1, 2018, and the updates have now been made in the UMCM – see Resources below.   As of September 1, 2018, all Texas Children’s Health Plan-contracted providers of Medically Dependent Children Program (MDCP) services are required to report all critical incidents, including Abuse, Neglect, and Exploitation (ANE), to the health plan. This action is to meet federal requirements regarding critical incident reporting (see links to federal requirements for incident reporting in below ‘Resources’ section).   MDCP providers contracted...

By Primary Care Providers, Specialists, , , , 0 CommentsRead more...
11Jun

OB/GYN appointment availability standards

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.                   **Texas Children’s Health Plan periodically surveys each participating provider to ensure that members are able to...

By OB/GYNs, , 0 CommentsRead more...
Provider Alert!
10Jun

Provider Alert! Reminder: Texas Children’s Health Plan Claims Editing System (CES) Update

Attention:  All Providers Update: Texas Children’s Health Plan Claim Editing System Texas Children’s Health Plan (TCHP) recently sent a Provider Alert updating our plan to transition to a new Claims Editing System (CES) by Optum on May 31, 2019. Please be advised this transition will now include edits specific to Texas and National Medicaid and the transition will occur in June 2019. This was initially scheduled to be done later in the year as another phase of the project, however we...

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