Facilities

Articles with relevant information about Facilities.

Provider Alert!
01Jun

Provider Alert! You’re Invited to Our Provider Advisory Group!

Date: June 1, 2023 Attention: All Providers Event dates for the upcoming sessions are based on Service Delivery Area: Tuesday, June 13, 2023 Northeast SDAThursday, June 15, 2023 Jefferson SDATuesday, June 20, 2023 Harris SDAAll sessions will be from 6:00 – 7:30PM CST Call to action: Texas Children’s Health Plan (TCHP) invites you to join our quarterly Provider Advisory Group (PAG). We will hold our next round of sessions later this month and dates are based on Service Delivery Area (SDA) as described above....

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Provider Alert!
24May

Provider Alert! Clinical Criteria Revision for Evkeeza® effective June 1, 2023

Date: May 18, 2023 Attention: All Providers Effective Date: June 1, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective June 1, 2023, Texas Health and Human Services (HHSC) will expand coverage for Evkeeza® (procedure code J1305) to adolescents 5 years of age and older due to a recent U.S. Food and Drug Administration (FDA) approval. Evkeeza® is an injectable prescription medicine used along with other low-density lipoprotein (LDL) lowering medicines in treating high cholesterol...

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16May

Provider Alert! Infection Control Supplies Procedure Code S8301 No Longer a Benefit

Date: May 16, 2023 Attention: All Providers Effective Date: May 12, 2023 Call to action: Texas Children Health Plan (TCHP) would like to inform providers that effective with the end of the federal public health emergency (PHE) on May 11, 2023, the Health and Human Services Commission (HHSC) will end multiple temporary flexibilities related to the COVID-19 pandemic. Providers should be aware that this change impacts coverage and reimbursement for procedure code S8301for infection control supplies. Effective for dates of service on or after May...

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15May

Provider Alert! End of COVID flexibilities: Provider Signatures for All Therapy Services and Hearing Screening for Speech Therapy

Date: May 15, 2023 Attention: All Providers Effective date: June 13, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to make providers aware of the end to some COVID flexibilities related to Utilization Management.  Background information: The Health and Human Services Commission (HHSC) received notice that the COVID-19 federal public health emergency (PHE) declared on January 31, 2020, will end on May 11, 2023. In response to the PHE, TCHP implemented additional flexibilities during this time that will come to an...

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Provider Alert!
11May

Provider Alert! Inactive National Provider Identifiers in National Plan and Provider Enumeration System to Trigger Disenrollment Action

Date: May 10, 2023 Attention: All Providers Effective date: April 27, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to make providers aware that Texas Medicaid and Healthcare Partnership (TMHP) has identified several National Provider Identifiers (NPI) as inactive in the National Plan and Provider Enumeration System (NPPES) and will be taking immediate disenrollment action which will result in a payment denial code (PDC) 64 added on to the provider record in the Master Provider File (MPF). Provider Requirements, verification and...

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09May

Provider Alert! HHSC to End Telephone (Audio-only) Medical Services COVID-19 Guidance and Issue Temporary Guidance for Certain Audio-Only Services

Date: May 8, 2023 Attention: All Providers Effective date: May 12, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective May 11, 2023, Health and Human Services Commission (HHSC) will end the temporary flexibility that has been allowed for telephone (audio-only) medical (physician-delivered) E/M services. HHSC authorized providers to bill procedure codes 99201-99205 and 99211-99215 to receive reimbursement for telephone (audio-only) medical (physician-delivered) E/M services delivered from March 20, 2020, through May 11, 2023. Billing information: Providers should...

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Provider Alert!
09May

Provider Alert! Subject: Unclassified Medical Drugs Prior Authorization Requirement

Date: May 8, 2023 Attention: All Providers Effective Date: June 8, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective June 8 2023, medical claims under $5,000 submitted to TCHP with unclassified Healthcare Common Procedure Coding System (HCPCS) code J3490 will no longer require a pre-service (prior authorization) request as claims above this cost will be subject to clinical necessity review by the pharmacy team. This dollar limit does not apply to other unclassified codes J9999, J3590,...

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Provider Alert!
08May

Provider Alert! Provider Offices Are Eligible for Incentive with Completion of Appointment Accessibility Survey

Date: May 8, 2023 Attention: Primary Care and Specialist Providers Launch timeframe: Summer 2023 Call to action: Texas Children’s Health Plan (TCHP) is excited to launch our annual Provider Appointment Accessibility this summer- this time with a new feature. Providers that complete the survey will be entered into a gift card drawing*. Winning practices will be contacted at the conclusion of the survey. Background information: In 2015, Senate Bill 760 passed, requiring Texas Health and Human Services Commission (HHSC) to monitor the provider networks...

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08May

Provider Alert! Monovalent Moderna and Pfizer-BioNTech COVID-19 Vaccines Removed From Formulary on April 21, 2023

Date: May 8, 2023 Attention: All Providers Effective Date: April 21, 2023 Call to action: Texas Children Health Plan (TCHP) would like to inform providers that effective April 21, 2023, the U.S. Food and Drug Administration (FDA) amended the emergency use authorizations of the Moderna and Pfizer-BioNTech COVID-19 bivalent mRNA vaccines. This is to simplify the vaccination schedule for most individual vaccines, and monovalent are no longer authorized for use in the United States. This announcement includes authorizing the current bivalent vaccines (original and...

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Provider Alert!
04May

Provider Alert! Quantity Limit Change for Direct Antivirals Scheduled for May 25, 2023

Date: May 4, 2023 Attention: All Providers Effective Date: May 25, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective May 25, 2023, the Health and Human Services Commission (HHSC) is implementing new policies to improve access and adherence to direct antivirals. Providers will now be able to write prescriptions for the entire course of therapy for the direct antivirals, eliminating the need for additional refills. How this impacts providers: Starting May 25, 2023, due to...

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