Articles with relevant information for OB/GYNs
New claim appeal form can be found at http://www.texaschildrenshealthplan.org/for-providers/resources/downloadable-forms Please note that providers must file an appeal within 120 days from the date of the denial for reconsideration.
Encourage your patients to be a part of the Baby Box movement, which promotes safe sleep for infants! Texas has become the 4th state to launch Baby Box University, which helps new parents give their babies a healthy start in life. The Baby Box program is designed to encourage mothers to get prenatal care and promote a good relationship between moms-to-be and their doctors. By completing an online syllabus through the company’s educational platform, Baby Box University, all new and expecting...
A new resource for screening, diagnosis and treatment of postpartum depression. Click here to view this helpful resource for postpartum depression: http://www.texaschildrenshealthplan.org/sites/default/files/pdf/the_texas_clinicians_postpartum_depression_toolkit%20FINAL.pdf
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 be...
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 by...
This is a chance to interact with members outside the office in a relaxed setting. What: Member-Provider Collaborative Event On Interconception Care When: Thursday, June 8, 201, 12 p.m. to 2 p.m. Where: The Center for Children and Women-Southwest, 9700 Bissonnet, Houston, TX 77036 RSVP by May 26 to Diane Nunez Email: Diane.nunez@tchp.us Phone: 832-828-1430 Lunch will be served!
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 List...
Effective January 1, 2017, Texas Children’s Health Plan will reimburse providers for maternal depression screening conducted at a well-child visit. Postpartum depression screening utilizing the Edinburgh Postnatal Depression Scale may be reimbursed up to 2 times per member ages 0-6 months, using CPT code 96161. Code 96161 is used to report the use of a standardized instrument to screen for health risks in the caregiver for the benefit of the patient. The reimbursement for this code will be based on...
Texas Children’s Health Plan is excited to announce the upcoming implementation of Clear Coverage for inpatient authorization requests beginning May 1, 2017. Clear Coverage is a web-based system that provides an automated method for providers and health plans to manage authorizations for inpatient services at the point of decision. Clear Coverage enables automated authorization, notification, eligibility and direction of members to in-network service providers. Clear Coverage provides the following benefits: Providers have immediate access to coverage, medical appropriateness and network rules,...
Lou Fragoso has been appointed president of Texas Children’s Health plan. He joined Texas Children’s Pediatrics in February 2014 and was vice president of Business Operations. Prior to joining Texas Children’s, Lou was in leadership roles at Baylor College of Medicine in Houston and at Lurie Children’s Hospital in Chicago. Lou is a Certified Public Accountant with over 20 years of healthcare finance and management experience. Since joining Texas Children’s Pediatrics, Lou spearheaded the creation of Texas Children’s Urgent Care. Texas...
