Office Managers – Page 12

Articles with relevant information for Office Managers.

21JulJuly 21, 2023

Provider Alert! Medicaid Preferred Drug List and Formulary Changes

Date: July 21, 2023 Attention: All Providers Effective Date: July 27, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective July 27, 2023, select medication(s) moved from “preferred” to “non-preferred” status. A summary of the changes is included below. Resource: https://www.txvendordrug.com/formulary/preferred-drugs Changes with biggest impact to Texas Children Health Plan members and providers: The drugs listed below were either not previously reviewed (NR) and became non-preferred (NPD) or previously considered a preferred agent (PDL) but now have changed...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialistsformulary changes, medicaid, PDL, Preferred Drug List0 CommentsRead more...

19JulJuly 19, 2023

Provider Alert! Prior Authorization Updates for Neurostimulators and Neuromuscular Stimulators

Date: July 18, 2023 Attention: All Providers Effective date: July 1, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers of a new prior authorization requirement effective July 1, 2023, for neurostimulators and transcutaneous electrical supply- CPT Code A4560. How this impacts providers: This prior authorization requirement aligns with the TMPPM and applies to all lines of business CHIP, STAR, and STAR Kids. There is a limit to one unit every 12 weeks or four units per year. Source: Texas...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, SpecialistsNeuromuscular Stimulators, Neurostimulators, Prior Authorization0 CommentsRead more...

19JulJuly 19, 2023

Provider Alert! Zynteglo® now a Medicaid and CHIP Benefit – Prior Authorization Effective September 1, 2023

Date: July 18, 2023 Attention: All Providers Effective Date: September 1, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective September 1, 2023, the Texas Health and Human Services (HHSC) will be implementing required prior authorization criteria for Zynteglo® (procedure code J3590) for Medicaid and CHIP. Zynteglo® became a benefit of Medicaid and CHIP on July 1, 2023. Zynteglo® (betibeglogene autotemcel) is an autologous stem cell-based gene-therapy indicated for treating adult and pediatric patients with...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, SpecialistsCHIP, gene therapy, medicaid, Prior Authorization, Zynteglo0 CommentsRead more...

13JulJuly 13, 2023

Provider Alert! No-cost sports and school physicals for CHIP and Medicaid patients

Date: July 13, 2023 Attention: Primary Care Providers, OB/GYNs, and Office Managers Call to action: It will soon be back-to-school season, which means your patients will need to complete their annual sports and school physicals. As part of the Healthy Rewards Program*, Texas Children’s’ Health Plan CHIP, STAR and STAR Kids members ages 5 to 19 years** can receive a no-cost sports and school physical. A Texas Health Steps or well-child visit within the last 12 months is required. Members should bring...

By Texas Children's Health PlanOB/GYNs, Office Managers, Primary Care Providers, Provider AlertCHIP, medicaid, School Physicals0 CommentsRead more...

13JulJuly 13, 2023

Provider Alert! Signature Updates to Home Health Prior Authorization Request Forms

Date: July 12, 2023 Attention: All Providers Effective date: July 1, 2023 Call to action: The purpose of this communication is to provide awareness that the signature requirements for Title XIX (Medicaid) Home Health Services have changed. Medicaid-enrolled physicians and allowed practitioners can now sign prior authorizations and order covered Medicaid Home Health Services, including skilled nursing, home health aide services, durable medical equipment and supplies, and adult physical and occupational therapy services. An allowed practitioner is a physician assistant (PA) or an advanced...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, SpecialistsHome Health Services, medicaid, Medicaid Services, Prior Authorization0 CommentsRead more...

13JulJuly 13, 2023

Provider Alert! Clinical Criteria for Tzield® (procedure code J9381) effective August 1, 2023

Date: July 11, 2023 Attention: All Providers Effective Date: August 1, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective August 1, 2023, the Texas Health and Human Services (HHSC) will be implementing prior authorization criteria for Tzield ® (procedure code J9381). The approval duration will be for the 14-day treatment. Tzield is the first-in-class therapy indicated to delay the onset of Stage 3 Type 1 diabetes (T1D) in adults and pediatric patients 8 years...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialistsclinical criteria, diabetes, Monoclonal Antibody, Tzield0 CommentsRead more...

07JulJuly 7, 2023

Provider Alert! Noninvasive Prenatal Screening Benefits to Change for Texas Medicaid July 1, 2023

Date: July 7, 2023 Attention: All Providers Effective Date: July 1, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective July 1, 2023, noninvasive prenatal screening (NIPS) benefits will change for Texas Medicaid. How this impacts providers: Effective July 1, 2023, major changes to this medical benefit include the following: Updated benefit eligibility criteria Removed fee-for-service (FFS) prior authorization requirement NIPS is a benefit for members who have a confirmed intrauterine singleton pregnancy dated at least ten weeks gestation. Members...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, SpecialistsAuthorization, NIPS, noninvasive, prenatal, Procedure Codes, screening0 CommentsRead more...

23JunJune 23, 2023

Provider Alert Texas Health Steps Dental Services Reminder

Date: June 23, 2023 Attention: Primary Care Providers Call to action: Due to an increase in the number of TCHP members utilizing emergency services for dental-related visits, we would like to remind providers of the importance and availability of preventive dental care for children receiving Texas Health Steps services. Additionally, almost 23 percent of US children ages 2 through 5 have experienced dental caries in primary teeth, highlighting the need for early preventive services. Early childhood cavities are the most common chronic...

By Texas Children's Health PlanOB/GYNs, Office Managers, Primary Care Providers, Provider Alert, SpecialistsDental, THSteps0 CommentsRead more...

22JunJune 22, 2023

Provider Alert! New Fax Line for Post Hospital Discharge Authorizations

Date: June 22, 2023 Attention: All Providers Effective date: July 1, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers of a recent update to the prior authorization fax lines. On July 1, 2023, a new line will be added. This fax line will be used to send in authorization requests for members who are hospitalized at the time of request and services or equipment that are necessary for care of the member immediately after discharge. Requests unrelated to discharge...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, SpecialistsAuthorization, discharge, Hospital, post hospital0 CommentsRead more...

20JunJune 20, 2023

Provider Alert! HHSC to Add New Qulipta® Indication to Clinical Prior Authorization

Date: June 20, 2023 Attention: All Providers Effective Date: June 27, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective June 27, 2023, Texas Health and Human Services (HHSC) will follow the Food and Drug Administration’s recent approval of new indication for atogepant (Qulipta®), to prevent chronic migraine in adults. How this impacts providers: Starting June 27, 2023, TCHP will implement the new indication for atogepant (Qulipta®) to prevent chronic migraine in adults. The new criteria...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialistsclinical prior authorization, Qulipta0 CommentsRead more...