Office Managers

Articles with relevant information for Office Managers.

Provider Alert!

Provider Alert! Acute Therapy Services

Acute Therapy Services Requests for acute occupational speech and physical therapy services will require documentation from the prescribing provider that a visit for the acute injury or acute exacerbation of the medical condition requiring therapy has occurred within the last 90 days. Acute speech therapy authorization will not require evidence of current Texas Health Steps well checkup for therapy treatment requests of 60 days or less. Therapy services for greater than 60 days will require evidence that the member is current in [...]

Provider Alert!

Provider Alert! Reimbursement Rate Changes for PCS, PDN & Therapy Services

Date: October 16, 2019 Attention: Home Health, Therapy and LTSS Providers Subject: Reimbursement Rate Changes for PCS, PDN & Therapy Services Effective Date: September 1, 2019 Call to action: On August 28, 2019, Texas Children’s Health Plan (TCHP) received notice of the rate changes from Texas Medicaid Healthcare Partnership (TMHP) effective September 1, 2019.  The services impacted by the Medicaid-implemented rate changes include: Personal Care Services (PCS) Private Duty Nursing (PDN) Therapies for Children in the Home Therapy Assistants TCHP is in the process of implementing the updates [...]

Provider Alert!

Provider Alert! DME/equipment/supplies exceeding Texas Medicaid Limitations

Effective October 1, 2019, Texas Children’s Health Plan will implement a prior authorization process for providers to request prior approval to provide DME/Equipment/Supplies to members 20 years of age and under in excess of benefit limitations. Texas Children’s Health Plan applies benefit limitations for DME/Equipment/Supplies in accordance with the Texas Medicaid Provider Procedure Manual (TMPPM) for all members eligible to receive the benefit, except for the following:   Next steps for providers: DME/Equipment/Supplies for a member who is 20 years of age or [...]

Provider Alert!

Provider Alert! Update: Prior Authorization Requirements

Please note the following key prior authorization requirement changes for providers. Updates: Effective July 1, 2019 Psychological testing (procedure codes 96130, 96131, 96136, and 96137), neurobehavioral testing (procedure codes 96116 and 96121), and neuropsychological testing (procedure codes 96132, 96133, 96136, and 96137) are limited to four hours per member, per day and eight hours per member, per calendar year. Prior Authorization will not be required when billed within these limits. Additional hours require prior authorization. Botulinum toxin injections will only require authorization [...]

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 care Minor home modifications Adaptive aids Transition assistance services Employment assistance Supported employment Financial management services The purpose of enrolling a [...]

Texas Children’s Health Plan increases yearly gastrostomy button (G-button) limits

A message from Dr. Katy Ostermaier, Medical Director of STAR Kids at Texas Children’s Health Plan Texas Children’s Health Plan is pleased to announce an increase in gastronomy button (G-button) limits per year. As of February 26, 2019, we now allow 6 G-buttons to be dispensed per year. Families who have children with G-buttons can have a hard time getting the supply of replacement G-buttons needed when they break. An active child may need to replace broken G-buttons often, but Texas [...]

The new and improved Provider Portal is here!

The upgraded Texas Children’s Health Plan Provider Portal is now live! We have worked to bring a revamped user experience to our entire provider network. Our goal is to empower our providers with the tools to access accurate, timely data, so that they are able to deliver the best possible care to our members and their families. The redesigned portal features: Improved functionality for the claims, appeals, and messaging center Health Management Tools menu Access to Healthcare Effectiveness Data and Information Set (HEDIS®) [...]