News Blog
26Apr

Appointment Availability Standards

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...

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25Apr

Texas Children’s Health Plan partners with Baylor College of Medicine to address and prevent opioid abuse in perinatal populations

Women of childbearing age have been disproportionately impacted by the opioid epidemic. Consequently, the rates of in utero drug exposure and Neonatal Abstinence Syndrome have increased dramatically over the last decade.  In Texas, overdose is the leading cause of maternal death in the first postpartum year. To prevent and respond to these issues, faculty from Baylor College of Medicine and Texas Children’s Health Plan were recently awarded funding from the Office of National Drug Control Policy’s grant program entitled Combating Opioid...

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24Apr

Prior Authorization Reference Information

The Texas Children’s Health Plan website now has an additional resource for information related to prior authorization requirements. The Prior Authorization Reference Information documents the codes that require authorization for payment based on authorization category. This list is not yet all-inclusive. It can be found at: https://www.texaschildrenshealthplan.org/sites/default/files/pdf/PA%20Code%20List%20December%202018.pdf In addition, providers can submit an authorization request online for the codes listed on the Prior Authorization Reference Information document via Clear Coverage. For access to or training on the use of Clear Coverage,...

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23Apr

Update to Children’s Services Handbook THSteps Medical Checkups

Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, pre-certification, referrals, and claims/encounter data filing may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the client's specific MCO for details. Beginning February 1, 2019, TMHP will update the Texas Medicaid Provider Procedures Manual, Volume 2, Children’s Services Handbook, subsection 5.3.6 “Texas Health Steps Medical Checkups,” to remove the referral indicator requirement and...

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Provider Alert!
22Apr

Provider Alert! Governor Greg Abbott Issues Disaster Declaration for Cherokee, Freestone, Houston, Leon, Madison, Nacogdoches, Robertson, San Augustine, and Shelby Counties.

On April 18, 2019: Governor Greg Abbott issued a disaster declaration for the following counties Cherokee, Freestone, Houston, Leon, Madison, Nacogdoches, Robertson, San Augustine, and Shelby counties. If a member resides in one of these impacted areas named above Texas Children’s Health Plan will make every effort to assist them in obtaining medically necessary services. PHARMACY: Navitus Pharmacy update related to disaster declaration: Navitus has implemented the "Disaster Declaration and Refill Too Soon" process as a result of the severe weather, including thunderstorms and tornado events...

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Provider Alert!
09Apr

Provider Alert! DME/Supplies Exceeding Medicaid Limitations

Date: 04/09/2019 Subject: DME/Supplies Exceeding Medicaid Limitations Attention: DME and Home Health Providers Texas Children’s Health Plan applies benefit limitations for DME Supplies and Equipment per the current TMHP Manual for all members eligible to receive the benefit. See benefit exceptions below. Frequency of Billing As a reminder, DME monthly limits will be applied every 27 days. Claims for recurring DME rentals and/or monthly disposable supplies billed prior to this renewal date are subject to denial. Denied claims may be appealed through the standard appeal process...

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21Mar

Smoking cessation help available for parents and caregivers

Smoke-free homes lead to better health outcomes and reduced ED admissions for patients with asthma. Texas Children’s Health Plan provides free smoking cessation counseling and up to $75 of nicotine replacement products for the parents and caregivers of members with asthma. As a provider, you can help your patients more by supporting smoking cessation for parents and caregivers. If your practice site is interested in learning how to enroll parents/caregivers in this program, please contact Texas Children’s Health Plan’s Care...

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Provider Alert!
18Mar

Provider Alert! Update: Reimbursement Code for Sports and Camp Physicals

As spring training and sports begin, it’s an ideal time to ensure that all members are receiving their Texas Health Steps check ups timely. Texas Children’s Health Plan wants to remind our pediatric providers about sports physicals as value-added services. Members aged 5 - 19 (STAR & CHIP), 5 – 20 (STAR Kids) who have had a Texas Health Steps check up in the last 12 months will be eligible for one annual sports and school physical delivered by their Primary...

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Provider Alert!
02Mar

Provider Alert! Prior Authorization

Prior authorization alert Effective January 1, 2019, Texas Children’s Health Plan updated the prior authorization listing. Please note there are some key changes for providers. Removed from the list and will no longer require prior authorization: Baclofen Pump New to the list: Home Telemonitoring Updates: Ambulance (non-emergent transport) has been updated to Non-Emergency Ambulance Transport. Augmentative Communication Device has been updated to Augmentative Communication Device and Accessories. Chemotherapy non-FDA approved has been updated to Non-FDA approved medications. Cranial Molding Orthosis (Helmets) has been updated to Cranial Molding Orthosis. High cost (>$50,000) injectable...

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01Mar

Texas Children’s Health Plan partners with Baylor College of Medicine to address and prevent opioid abuse in perinatal populations

Women of childbearing age have been disproportionately impacted by the opioid epidemic. Consequently, the rates of in utero drug exposure and Neonatal Abstinence Syndrome have increased dramatically over the last decade.  In Texas, overdose is the leading cause of maternal death in the first postpartum year. To prevent and respond to these issues, faculty from Baylor College of Medicine and Texas Children’s Health Plan were recently awarded funding from the Office of National Drug Control Policy’s grant program entitled Combating Opioid...

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