Articles with relevant information about Facilities.

Provider Alert!

Provider Alert! 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 in [...]

Hospital – Facility Billing Neonatal Claims Must Submit Application for Neonatal Level of Designation before July 1, 2018

Attention:  All Hospitals Subject:  Hospitals Billing Neonatal Claims Must Submit Application for Neonatal Level of Designation before July 1, 2018 Effective immediately, hospitals rendering neonatal services must submit their neonatal designation applications to the Texas Department of State Health Services. Completed applications must be submitted before July 1, 2018. Applications received after July 1 will not be considered for approval. If an application is received after July 1, it will not be considered as submitted in time for approval by the executive commissioner [...]

Provider Alert!

Provider Alert! Uniform Hospital Rate Increase Program (UHRIP)

Attn: STAR HOSPITAL SERVICES RE: Uniform Hospital Rate Increase Program (UHRIP) Dear Provider, The Texas Health and Human Services Commission (HHSC) has received approval from the Centers for Medicare and Medicaid Services to implement the Uniform Hospital Rate Increase Program (UHRIP) for hospital services effective March 1, 2018 for Harris and Jefferson Service Delivery Areas (SDAs).  State-owned hospitals and institutions for mental diseases are excluded from the program. Texas Children’s Health Plan (TCHP) will be sending a Letter of Agreement to all eligible [...]

Upcoming Electronic Visit Verification (EVV) training sessions

Houston Date: November 7 & 8, 2017 The same information will be covered on both days, so providers only need to attend one session. Time: 9:00am – 4:00pm Location: Texas Children’s Hospital, The Woodlands Campus, 17580 Interstate 45 South, The Woodlands, TX 77384   Irving When: December 5 & 6, 2017 The same information will be covered on both days, so providers only need to attend one session. Time: 9:00am – 4:00pm Location: The Innovator’s Auditorium, 1660 N Westridge Drive Irving, TX 75038   Click here for more information

Notice to Prescribers: Mosquito Repellent Benefit

Texas covers select mosquito repellents for the prevention of Zika virus. The following notice describes how clients may access mosquito repellent through Medicaid and other state programs, and provides essential information for prescribers regarding the mosquito repellent benefit. Covered programs: Medicaid (managed care, MCO; and fee-for-service, FFS) AND Children's Health Insurance Program (CHIP) and CHIP-Perinatal Healthy Texas Women Children with Special Health Care Needs Services Program (CSHCN) Family Planning Program 1. Medicaid (FFS and MCO) and CHIP Clients The Texas Medicaid Medical Director has issued a Texas Medicaid [...]

TCHP now accepts Outpatient Authorizations for many services online via Clear Coverage effective June 1, 2017!

Tired of faxing authorization requests and medical records? Spending too much time on hold waiting to speak to an Authorization Specialist for non-urgent authorization request? Looking for a faster, more efficient way to submit authorizations? Why not submit your authorizations request through Clear Coverage? What are the benefits? Easy to access 24/7 online access to Clear Coverage Receive real time authorization status by viewing your office’s home page in Clear Coverage Services are immediately uploaded into Texas Children’s Health Plan’s authorization for clinical review Automatic APPROVALS may [...]

Provider Alert! Authorization Extension for STAR Kids Members

Attention STAR Kids Providers May 17, 2017 Authorization Extension for STAR Kids Members The Health and Human Services Commission expects managed care organizations to extend long term services and supports (such as Personal Care Services, Community First Choice, and Private Duty Nursing) authorizations for services until completion of the STAR Kids Screening and Assessment Instrument (SAI), but no longer than July 1, 2017. In order to receive payment for these services, you must have authorization from Texas Children’s Health Plan, and the SAI must be completed [...]

No Prior Authorizations Required for Texas Children’s Health Plan (TCHP) In-Network Observations

1. In-network Observation stays do not require prior-authorization. 2. Hospital stays that include less than two bed days (less than “two midnights”) at the time of submission will be categorized as Observation Level of Care with some exceptions: a. Obstetrical deliveries b. Patient deaths c. Against Medical Advice (AMA) discharges d. Intensive Care Unit (ICU) admissions e. Pediatric Intensive Care Unit (PICU) admissions f. Pediatric Progressive Care Unit (PCU) g. Initial Neonatal Intensive Care Unit (NICU) admissions h. Neonatal Intensive Care Unit (NICU) readmissions within 28 days i. Behavioral [...]

Zika Prevention: Mosquito Repellant Benefit Now Available

What the mosquito repellent benefit? Texas Children’s Health Plan now covers select mosquito repellents for eligible members to prevent contraction of the Zika virus. This benefit is covered through Texas Children’s Health Plan’s prescription benefits at no cost to eligible members. Which Texas Children’s Health Plan members are eligible for this benefit? Females ages 10-55 years Pregnant women of any age Males ages 14 years and older Does an eligible member require a prescription to receive mosquito repellant? No. The Texas Medicaid Medical Director [...]

Need Help Navigating Pharmacy Prior Authorizations?

Pharmacy Prior Authorizations (PAs) can be a difficult administrative burden for providers and staff, however, they help ensure patients are receiving the most evidence-based, cost-effective medications. The Vendor Drug Program (VDP) is the state resource for the Texas Medicaid formulary and Preferred Drug List (PDL).  VDP has provided a very helpful guide to managing pharmacy benefits for your patients. You can access this resource here: http://casestudies.txhealthsteps.com/stepsQuickCourses/prescribers/ This Quick Course reviews the following: Searching Formulary for prescription and OTC drugs Checking the Preferred Drug [...]