Facilities – The Checkup

26 Sep

Provider Alert! Drug Regimen Optimization Edit Removed After September 12

Date: September 20, 2022 Attention: All Providers Effective Date: September 12, 2022 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated with 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: Beginning September 12, 2022, Texas Children's Health Plan (TCHP) will remove the Drug Regimen Optimization prior authorization for all drugs except ADHD drugs. The [...]

By Texas Children's Health Plan Primary Care Providers, OB/GYNs, Office Managers, Specialists, Facilities, Provider Alert ADHD, Prior Authorization, add, drug, Drug Regimen, Optimization 0 Comments Read more...

26 Sep

Provider Alert! Prior Authorization Criteria Update for Zolgensma

Date: September 20, 2022 Attention: All Providers Effective Date: November 11, 2022 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated with 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 providers that effective November 1, 2022, the Health and Human Services Commission (HHSC) will update [...]

By Texas Children's Health Plan Primary Care Providers, OB/GYNs, Office Managers, Specialists, Facilities, Provider Alert Prior Authorization, Zolgensma 0 Comments Read more...

26 Sep

Provider Alert! Temporary Change in PDL Status for Antihypertensives, Sympatholytics Drug Class

Date: September 26, 2022 Attention: All Providers Effective Date: September 26, 2022 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: The Health and Human Services Commission (HHSC) is aware of a drug shortage for Catapres-TTS patches in the Antihypertensives, Sympatholytics drug class due [...]

By Texas Children's Health Plan Primary Care Providers, OB/GYNs, Office Managers, Specialists, Facilities, Provider Alert PDL Status, Sympatholytics, Antihypertensives 0 Comments Read more...

26 Sep

Provider Alert! Age and Diagnosis Restriction Updates for Cabenuva, Oncaspar, Zulresso

Date: September 22, 2022 Attention: All Providers Effective Date: October 1, 2022 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated with 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’s (TCHP) would like to inform providers that effective October 1, 2022, the age and diagnosis restrictions for Cabenuva (J0741), Zulresso [...]

By Texas Children's Health Plan Primary Care Providers, OB/GYNs, Office Managers, Specialists, Facilities, Provider Alert Prescriptions, age restriction, Diagnosis Restrictions 0 Comments Read more...

19 Sep

Provider Alert! Case Management for Children and Pregnant Women (CPW) Carve-In

Date: September 16, 2022 Attention: All Providers Effective date: September 1, 2022 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: The purpose of this communication is to inform our providers of the Case Management for Children & Pregnant Women (CPW) carve-in to Medicaid that [...]

By Texas Children's Health Plan Primary Care Providers, OB/GYNs, Office Managers, Specialists, Facilities, Provider Alert benefit, Case Management, CPW, Children and Pregnant Women, Carve-In 0 Comments Read more...

15 Sep

Provider Alert! Medicaid Preferred Drug List and Formulary Changes

Date: September 14, 2022 Attention: All Providers Effective Date: July 28, 2022 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated with 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 providers that the Texas Vendor Drug Program (VDP) implemented changes to the state Medicaid drug [...]

By Texas Children's Health Plan Primary Care Providers, OB/GYNs, Office Managers, Specialists, Facilities, Provider Alert Vendor Drug Program, VDP, PDL, Preferred Drug List, formulary changes 0 Comments Read more...

13 Sep

Provider Alert! Private Duty Nursing Fee Schedule Review

Date: September 13, 2022 Attention: Private Duty Nursing 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) is aware that some providers are seeing reduced payments for Private Duty Nursing (PDN) claims with dates of service on or after [...]

By Texas Children's Health Plan Primary Care Providers, OB/GYNs, Office Managers, Specialists, Facilities, Provider Alert private duty nursing, PDN, nursing, fee schedule 0 Comments Read more...

13 Sep

Provider Alert! Prior Authorization Criteria to Change for Some CAR T-Cell Infusion Therapies

Date: September 13, 2022 Attention: All Providers Effective Date: September 1, 2022 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated with 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 providers that the Health and Human Services Commission (HHSC) will update the prior authorization criteria [...]

By Texas Children's Health Plan Primary Care Providers, OB/GYNs, Office Managers, Specialists, Facilities, Provider Alert Prior Authorization, cancer, breyanzi, lymphoma, Infusion, yescarta, Infusion Therapy, T-Cell 0 Comments Read more...

13 Sep

Provider Alert! RSV Summer Season Changes Begin September 1

By Texas Children's Health Plan Primary Care Providers, OB/GYNs, Office Managers, Specialists, Facilities, Provider Alert RSV, hhsc, VDP, Respiratory Syncytial Virus 0 Comments Read more...

13 Sep

Provider Alert! Hepatitis C Treatment Coverage and PDL Update Delayed to Jan. 1, 2023

Date: September 12, 2022 Attention: All Providers Effective Date: September 1, 2022 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated with 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 providers that on January 1, 2023 Texas Medicaid will designate one medication as the primary [...]

By Texas Children's Health Plan Primary Care Providers, OB/GYNs, Office Managers, Specialists, Facilities, Provider Alert hhsc, Hepatitis C, Hep C, anti-venom, DAA, METAVIR 0 Comments Read more...