OB/GYNs

Articles with relevant information for OB/GYNs

Provider Alert!
28Jan

Provider Alert! Removal of Specialist Requirement from Clinical Prior Authorization Criteria

Date: January 28, 2022 Attention: Providers Effective Date: January 3, 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: Effective January 3, 2022, HHSC removed the specialist requirement from the following clinical prior authorization criteria: CGRP Antagonist, Acute CGRP Antagonists, Chronic Emflaza Ophthalmic Immunomodulators Palforzia Transthyretin Agents VMAT2 Inhibitors Wakix Xyrem/Xywav Zelboraf How this impacts providers: Providers...

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Provider Alert!
28Jan

Provider Alert! Prior Authorization Criteria for Enzyme Replacement Therapy

Date: January 28, 2022 Attention: Providers Effective Date: March 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: Effective March 1, 2022, HHSC will require prior authorization for all enzyme replacement therapies for Medicaid and CHIP. Enzyme replacement therapy (ERT) is a medical treatment...

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Provider Alert!
25Jan

Provider Alert! Medicaid Preferred Drug List and Formulary Changes

Date: January 25, 2022 Attention: All Providers Subject: Medicaid Preferred Drug List and Formulary Changes Effective Date: January 27, 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 Texas Vendor Drug Program (VDP) implemented changes to the state Medicaid drug formulary, effective Thursday, January 27, 2022....

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Provider Alert!
14Jan

Provider Alert! Stimate Nasal Spray National Drug Shortage

Date: January 14, 2021 Attention: All Providers Subject: Stimate Nasal Spray National Drug Shortage Effective date: December 16, 2021 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 Texas Health and Human Services Comission (HHSC) was made aware of a voluntary recall issued by Ferring Pharmaceuticals for...

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06Jan

Provider Alert! COVID-19 At-home Test Kits Available as a Pharmacy Benefit

Date: January 4, 2022 Attention: All Providers Effective date: January 3, 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: HHSC will allow COVID-19 at-home test kits as a Medicaid and Children’s Health Insurance Program (CHIP) pharmacy benefit beginning January 3, 2022. Members may obtain COVID-19 at-home...

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06Jan

Provider Alert! Pfizer Oral COVID-19 Drug, Paxlovid, Added to Formulary

Date: January 5, 2022 Attention: All Providers Effective Date: December 27, 2021 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: Health and Human Services Commission (HHSC) added Paxlovid to the Medicaid and Children’s Health Insurance Program (CHIP) formulary as a payable pharmacy benefit on December 27,...

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Provider Alert!
05Jan

Provider Alert! Texas Children’s Health Plan’s Cultural Competency Plan and Learning Opportunity

Date: January 3, 2022 Attention: All 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 fosters an environment of diversity, equity and inclusion by providing the right resources for our network of providers to better serve our culturally diverse member population....

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Provider Alert!
28Dec

Provider Alert! Prior Authorization Criteria for Aduhelm

Date: December 28, 2021 Attention: All Providers Effective Date: January 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: HHSC will add the drug Aduhelm (procedure code J0172) as of Jan. 1, 2022 and implement these criteria for fee-for-service Medicaid on Feb. 1, 2022. Key Details:...

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20Dec

Provider Alert! CHIP Perinatal Members Eligible for COVID-19 Vaccine

Date: December 20, 2021 Attention: All Providers Effective Date: December 11, 2021 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: Effective December 11, 2020, CHIP Perinate members enrolled in CHIP Perinatal services are eligible to receive the COVID-19 vaccine. The CHIP Perinatal (CHIP-P) Program serves the...

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Provider Alert!
29Nov

Provider Alert! Well Child and Texas Health Steps Visit reminder

Date: November 22, 2021 Attention: PCP, OB/GYN and Endocrinologist Providers Call to action: Texas Children’s Health Plan (TCHP) would like to remind you of the National Committee for Quality Assurance (NCQA) HEDIS Technical Specifications. How this impacts providers: Please submit all claims timely, as soon as services are rendered, and use appropriate codes to reflect the services provided particularly for Well-Care Visits and THSteps. Well-Child Visits in the First 30 Months of Life (W30) Two rates will be measured: Well-Child Visits in the First 15 Months: Six...

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