OB/GYNs

Articles with relevant information for OB/GYNs

Provider Alert!
09Jun

Provider Alert! Clinical Prior Authorization Criteria Updates

Date: June 9, 2023 Attention: All Providers Effective Date: March 23, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that the Texas Health and Human Services (HHSC) will be implementing updated clinical prior authorization criteria for Allergen extracts, IIleal Bile Acid Transporter (IBAT) Inhibitors and Monoclonal Antibody Agents. Allergen Extracts Palforzia is indicated for an allergic reaction that may occur with accidental exposure to peanut. Palforzia  will require clinical criteria similar to that of other allergen extracts. The...

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Provider Alert!
09Jun

Provider Alert! Clinical Criteria Revision for Hereditary Angioedema Agents (HAE) effective June 1,2023

Date: June 9, 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, the Texas Health and Human Services (HHSC) added age and diagnosis restriction for HAE agents. Please see the drugs impacted below: DrugProcedure CodeAgeDiagnosisBerinert®J0597≥ 5 yearsD84.1Kalbitor®J1290≥ 12 yearsD84.1Firazyr®J1744≥ 18 yearsD84.1Takhzyro®J0593≥ 2 yearsD84.1 How this impacts providers: Starting June 1 2023, TCHP will have diagnosis and age restrictions for HAE agents including Berinert®, Kalbitor®, Firazyr® and...

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Provider Alert!
08Jun

Provider Alert! Temporary Extension to Submit Claim Appeals

Date: June 8, 2023 Attention: All Providers Texas Children’s Health Plan (TCHP) would like to notify providers that the timely filing deadline for claim appeals has been waived for Dates of Service: August 1, 2022 – July 31, 2023. TCHP is conducting a provider reimbursement review to ensure accurate provider payments following the implementation of our new claims processing system, Epic Tapestry, on August 1, 2022.  Claims identified with erroneous payments will automatically be adjusted. However, providers may also submit or resubmit appeals...

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Provider Alert!
08Jun

Provider Alert! Updates and Actions Required for Implementation of PEMS Master Provider File Regarding Address Differences

Date: June 7, 2023 Attention: All Providers Provider Enrollment Management System (PEMS) effective date: October 25, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that the effective date for PEMS is October 25, 2024. The collaborative testing between managed Care Organizations (MCOs) and Health and Human Services Commission (HHSC) determined that there are some providers with mismatched addresses in PEMS. The providers with these mismatched addresses will receive communication from TCHP. How this impacts providers: The communication from...

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Provider Alert!
06Jun

Provider Alert! Screening and Coding for Social Determinants of Health – Introducing Texas Children’s Family Resources

Date: June 5, 2023 Attention: Primary Care and Obstetric Care Providers Call to action: Are your patients struggling to meet their basic needs? Connect them today with Texas Children’s Family Resources to find food and housing assistance, help paying bills, and other free or reduced-cost programs. https://txchfamilyresources.org/ As stewards of our member’s care, Texas Children’s Health Plan (TCHP) would like to remind you of social determinants of health.  Social determinants of health (SDOH) are non-clinical societal and environmental conditions such as lack of access to...

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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!
01Jun

Provider Alert! HHSC to Implement Gattex® Clinical Prior Authorization on June 6, 2023

Date: May 31, 2023 Attention: All Providers Effective Date: June 6, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective June 6, 2023, Texas Health and Human Services (HHSC) will be implementing the Gattex® clinical prior authorization criteria, which was approved on April 28, 2023. How this impacts providers: Starting June 6, 2023, TCHP will implement the Gattex® clinical prior authorization criteria. The new criteria is available on the HHSC Vendor Drug Program website and can...

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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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Provider Alert!
24May

Provider Alert! Ensuring Timely Prenatal and Postpartum Visits Reminder

Date: May 17, 2023 Attention: Obstetric Care Providers Call to action: Texas Children’s Health Plan (TCHP) encourages OB/GYNs and other providers to take measures to ensure that your patients, our members, are receiving timely prenatal and postpartum visits. TCHP is committed to optimizing the quality of obstetric care provided to members during pregnancy and the postpartum period. Together, we can support healthy pregnancies, reduce maternal mortality and improve neonatal outcomes.  OB/GYNs and other providers are encouraged to share this communication with their staff...

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16May

Provider Alert! COVID-19 Vaccine Administration Procedure Code 0174A Is Now a Benefit of Medicaid and CHIP

Date: May 16, 2023 Attention: All Providers Effective date: Dates of service on or after March 14, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective for dates of service on or after March 14, 2023, in accordance with the U.S. Food and Drug Administration’s amended Emergency Use Authorizations, COVID-19 vaccine administration procedure code 0174A for the administration of the Pfizer-BioNTech COVID-19 vaccine booster is now a benefit of Texas Medicaid and CHIP for individuals 6...

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