Office Managers

Articles with relevant information for Office Managers.

May is Mental Health Awareness Month

May is Mental Health Awareness Month Year after year, more and more Americans face the reality of living with a mental illness. Despite their age, many young children show early signs of mental illness. These mental health problems are often clinically diagnosable, and can be a product of the interaction of biological, psychological, and social factors. “Half of all mental health disorders show first signs before a person turns 14 years old, and three quarters of mental health disorders begin [...]

Provider Alert! Texas Children’s Health Plan Claim Editing System Update

Attention:  All Providers Reminder: Texas Children’s Health Plan Claim Editing System Update   Texas Children’s Health Plan (TCHP) previously sent a Provider Alert notifying providers that an intended transition to a new Claims Editing System (CES) by Optum was to occur in December 2018. Please be advised that this transition will now be occurring May 31, 2019.  Any claims submitted May 31, 2019 and after, including corrected and adjusted claims, will be processed with the Optum CES edits. TCHP is required by Texas [...]

Appointment Availability Standards

Appointment availability standards What are appointment availability standards? How do you as a provider with Texas Children’s Health Plan play a role? In 2015 Senate Bill 760 passed, requiring Texas Health and Human Services Commission (HHSC) to monitor the provider networks of managed care organizations. Texas Children’s Health Plan would like to ensure members are able to schedule appointments with providers in accordance with the HHSC’s appointment accessibility guidelines.                                                 AFTER HOURS: Primary Care Physicians who are accessible 24 hours a day, seven [...]

Prior Authorization Reference Information

The Texas Children’s Health Plan website now has an additional resource for information related to prior authorization requirements. The Prior Authorization Reference Information documents the codes that require authorization for payment based on authorization category. This list is not yet all-inclusive. It can be found at: https://www.texaschildrenshealthplan.org/sites/default/files/pdf/PA%20Code%20List%20December%202018.pdf In addition, providers can submit an authorization request online for the codes listed on the Prior Authorization Reference Information document via Clear Coverage. For access to or training on the use of Clear [...]

Smoking cessation help available for parents and caregivers

Smoke-free homes lead to better health outcomes and reduced ED admissions for patients with asthma. Texas Children’s Health Plan provides free smoking cessation counseling and up to $75 of nicotine replacement products for the parents and caregivers of members with asthma. As a provider, you can help your patients more by supporting smoking cessation for parents and caregivers. If your practice site is interested in learning how to enroll parents/caregivers in this program, please contact Texas Children’s Health Plan’s [...]

Provider Alert! Update: Reimbursement Code for Sports and Camp Physicals

As spring training and sports begin, it’s an ideal time to ensure that all members are receiving their Texas Health Steps check ups timely. Texas Children’s Health Plan wants to remind our pediatric providers about sports physicals as value-added services. Members aged 5 - 19 (STAR & CHIP), 5 – 20 (STAR Kids) who have had a Texas Health Steps check up in the last 12 months will be eligible for one annual sports and school physical delivered by their [...]

Physician Incentive Program (updated Jan. 2019)

Texas Children’s Health Plan is introducing its new Physician Incentive Program in an effort to align with state performance and quality measures. The new program focuses on rewarding physician groups for reducing Potentially Preventable Emergency Room Visits (PPV) as well as improving utilization of preventive care based on the Healthcare Effectiveness Data and Information Set (HEDIS) measures. More Information

Telemedicine support now available

Texas Children's Health Plan supports the delivery of telemedicine, telehealth and telemonitoring services to its members. Telemedicine and telehealth services should be provided in compliance with standards established by the respective licensing or certifying board of the professional providing the services. Telemedicine and telehealth services do not require authorization when provided by an in-network provider, except in the case of telemonitoring services. Of note, Texas Children’s Health Plan will not cover telemedicine or telehealth services that are provided through only synchronous [...]

Texas Standard Prior Authorization Request Form compliance grace period has ended

Starting January 1, 2019, the 90-day grace period for compliance with the exclusive use of the Texas Standard Prior Authorization Request Form has ended. From this date forward, providers must use the Texas Standard Prior Authorization Request Form, which can be found at https://www.texaschildrenshealthplan.org/for-providers. Click on Downloadable Forms on the left-hand side, then click Standard Prior Authorization Form or Behavioral Health Authorization Form to download. As a reminder, the following essential information is required to start the authorization process: Member Name, [...]