Office Managers

Articles with relevant information for Office Managers.

Provider Alert!
12Feb

Provider Alert! Updated Prior Authorization Information for Benlysta (procedure code J0490) and Saphnelo (procedure code J0491)

Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers of prior authorization updates for Belimumab (Benlysta), procedure code J0490, and Anifrolumab-fnia (Saphnelo), procedure code J0491. Effective March 1, 2022, there is no prior authorization requirement for both, and age and diagnosis restrictions are indicated below. Benlysta (J0490) is indicated to treat the following:  Active, autoantibody-positive, systemic lupus erythematosus (SLE) in clients who are 5 years of age or older, and receiving standard therapy Adult clients with active Lupus Nephritis...

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Provider Alert!
06Feb

Provider Alert! You’re Invited to Our Provider Advisory Group!

Date: February 6, 2024 Attention: All Providers Event dates for the upcoming sessions are based on Service Delivery Area: Tuesday, March 19, 2024 Northeast SDA Thursday, March 21, 2024 Jefferson SDA Tuesday, March 26, 2024 Harris SDA All sessions will be from 12:00-1:30PM CST Call to action: Texas Children’s Health Plan (TCHP) invites you to join our quarterly Provider Advisory Group (PAG). We will hold our next round of sessions next month and dates are based on Service Delivery Area as described above. Click here if you...

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Provider Alert!
02Feb

Provider Alert! Class I Drug Recall Notification: Zenzedi

Date: February 1, 2024 Attention: Providers Effective date: Immediately Call to action: On January 24, 2024, Azurity Pharmaceuticals voluntarily recalled one (1) lot (F230169A) of Zenzedi® CII (dextroamphetamine sulfate tablets, USP) 30 mg due to mislabeled packaging. ProductNDC No.Lot No.Exp. DateShip Dates toWholesalersZenzedi®(dextroamphetaminesulfate tablets, USP)30 mg24338-856-03F230169A2025-0608/23/2023 –11/29/2023 How this impacts providers: Patients who received this medication within the ship dates of 8/23/23-11/29/23 are required to return the medication and receive a replacement.  Next step for Providers: Providers should inform their impacted patients and arrange for the...

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Provider Alert!
02Feb

Provider Alert! Clinical Implementation of Hormonal Therapy Agents Clinical Prior Authorization Effective March 1, 2024

Date: February 1, 2024 Attention: All Providers Effective Date: March 1, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective March 1, 2024, the Texas Health and Human Services (HHSC) will implement clinical prior authorizations to hormonal therapy agents. HHSC will implement criteria for the following procedure codes: J1000   (depo-estradiol cypionate, up to 5mg) J1071   (inj testosterone cypionate, 1 mg) J1380   (inj estradoiol valerate, up to 10 mg) J1950   (inj leuprolide acetate, per 3.75 mg) J1951   (inj leuprolide acetate, fensolvi, 0.25...

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Provider Alert!
01Feb

Provider Alert! Provider Type and Places of Service Update for Procedure Code 96372

Date: February 1, 2024 Attention: All Providers Effective date: January 1, 2024 Call to action: Texas Children’s Health plan (TCHP) would like to make providers aware that effective for dates of service on or after January 1, 2024, injectable medication administration procedure code 96372 may be reimbursed to Texas Health Steps medical providers for services rendered in the office, outpatient hospital and birthing center settings. Next step for Providers: Providers are not required to appeal the claims unless they are denied for additional reasons...

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Provider Alert!
19Jan

Provider Alert! Updated: Medicaid Preferred Drug List and Formulary Changes

Date: January 18, 2024 Attention: All Providers Effective Date: January 26, 2024 This is an update for a communication that was previously posted on 12/18/2023. Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective January  26, 2024, select medication(s) moved from “preferred” or “non-reviewed” 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)...

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08Jan

Provider Alert! Addition of Paxlovid (Pfizer Oral Covid-19 Drug) to Formulary

Date: January 8, 2024 Attention: Providers Effective date: January 4, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective January 4, 2024, the Texas Health and Human Services (HHS) added Paxlovid to the formulary. Paxlovid (nirmatrelvir co-packaged with ritonavir) is an oral antiviral tablet, is indicated for the treatment of mild-to-moderate COVID-19 in adults who are at high risk for progression to severe COVID-19, including hospitalization or death. How this impacts providers: Please see below for the list...

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Provider Alert!
05Jan

Provider Alert! Nutramigen LGG Powdered Infant Formula Recall

Date: January 5, 2024 Attention: All Providers Effective: December 30, 2023 Call to action: Texas Children’s Health Plan (TCHP) received notice of an urgent recall from The Food and Drug Administration (FDA) for certain Nutramigen Hypoallergenic Infant Formula Powder products due to possible Cronobacter sakazakii contamination. The FDA is alerting parents, caregivers and health care providers not to use the recalled products. These recalled powdered infant formulas may be contaminated with Cronobacter sakazakii, a bacterium that can cause severe illness caused by food contamination. No illnesses have...

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Provider Alert!
03Jan

Provider Alert! Rate Changes for Ambulatory Surgical Centers

Date: January 3, 2024 Attention: Ambulatory Surgical Centers (ASCs) Effective: June 1, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to notify providers that Texas Health and Human Services Commission (HHSC) revised fee-for-service reimbursement rates for Ambulatory Surgical Centers (ASCs) and Hospital ASCs effective June 1, 2023. These rate revisions shift from the group rate and locality code method of payment for each procedure code and instead assigns fees by procedure code. How this impacts providers: TCHP is reprocessing affected claims submitted with...

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Provider Alert!
03Jan

Provider Alert! New video, Mood Disorders in Primary Care

Date: January 2, 2024 Attention: All Providers Call to action: Texas Children Health Plan (TCHP) Care Coordination Team is pleased to provide a video on mood disorders available here, Mood Disorders in Primary Care.  The video is on Bipolar Disorder and Major Depressive Disorder in children and adolescents.  In the video, you will find not only a brief overview of the mood disorders, but also tips for engaging your patients and recommendations for when to refer your patient to a mental health...

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