Office Managers

Articles with relevant information for Office Managers.

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, [...]

Provider Alert! Prior Authorization Alert

Effective January 1, 2019, Texas Children’s Health Plan updated the prior authorization listing. Please note there are some key changes for providers. Removed from the list and will no longer require prior authorization: Baclofen Pump New to the list: Home Telemonitoring Updates: Ambulance (non-emergent transport) has been updated to Non-Emergency Ambulance Transport. Augmentative Communication Device has been updated to Augmentative Communication Device and Accessories. Chemotherapy non-FDA approved has been updated to Non-FDA approved medications. Cranial Molding Orthosis (Helmets) has been updated to Cranial Molding Orthosis. High cost (>$50,000) injectable in [...]

What is the Medically Dependent Children’s Program (MDCP) Waiver?

If you have STAR Kids patients, there’s a chance some of them receive the Medically Dependent Children’s Program (MDCP) waiver, which is a home and community based services program. The goal of this program is to support families and children by preventing institutionalization and hospitalization, while helping them remain safely in their homes with the appropriate services. Examples of these services include flexible family support service, respite, minor home modifications, adaptive aids, transition assistance services, employment assistance, supported employment, [...]

Dr. Katy Ostermaier joins Texas Children’s Health Plan as Medical Director for STAR Kids

This past fall, Texas Children’s Health Plan was thrilled to welcome Dr. Katy Ostermaier as the new Medical Director for STAR Kids. Dr. Ostermaier joins us from Texas Children’s Hospital, where she started the Special Needs Primary Care Clinic and served as the Clinic Chief for the Spina Bifida Clinic and the Down Syndrome Clinic. She completed medical school and her pediatric residency at Baylor College of Medicine, where she joined the faculty after completing her training. Dr. Ostermaier [...]

Reminder: Tdap Vaccine Coverage for CHIP Perinatal Members

This reminder is to ensure that all providers are knowledgeable on which vaccines are covered for CHIP Perinatal (CHIP-P) members. Based on guidance from the Centers for Disease Control and Prevention (CDC), American Academy of Pediatrics (AAP), and American College of Obstetricians and Gynecologists (ACOG), the Tetanus, Diphtheria, and Acellular Pertussis (Tdap) vaccine is routine prenatal care and is covered in CHIP-P. As noted in the ACOG committee opinion: “The overwhelming majority of morbidity and mortality attributable to pertussis infection occurs [...]

Provider Alert! TCHP Prior Authorization Requirement

Effective January 1, 2019, TCHP will be updating the prior authorization listing. Please note there are some key changes for providers. Removed from the list and will no longer require prior authorization: Baclofen Pump New to the list: Home Telemonitoring Updates: Ambulance (non-emergent transport) has been updated to Non-Emergency Ambulance Transport. Augmentative Communication Device has been updated to Augmentative Communication Device and Accessories. Chemotherapy non-FDA approved has been updated to Non-FDA approved medications. Cranial Molding Orthosis (Helmets) has been updated to Cranial Molding Orthosis. High cost (>$50,000) injectable in the [...]