Office Managers

Articles with relevant information for Office Managers.
07Jul

Provider Alert! Changes to Physical, Occupational, and Speech Therapy Benefits for All Ages

Effective for dates of service on or after September 1, 2017, physical therapy (PT), occupational therapy (OT), and speech therapy (ST) benefits for all ages will change for Texas Medicaid. Please review this link for changes to this medical benefit policy that applies to the following: Billing structure changes for PT, OT, and ST services Procedure codes end-dating August 31, 2017 Required modifiers Claims filing changes Clarification to benefits Providers may refer to the current Texas Medicaid Provider Procedures Manual, Physical Therapy, Occupational Therapy, and Speech Therapy...

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12Jun

Zika Virus Testing Requires Modifier U4 on Claims

Information posted May 5, 2017 Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, pre-certification, referrals, and claims/encounter data filing may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the client's specific MCO for details. Effective for dates of service on or after May 5, 2017, laboratory providers must include modifier U4 with procedure code 86790, 87798, or 87799 when submitting a claim...

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17May

TCHP now accepts Outpatient Authorizations for many services online via Clear Coverage effective June 1, 2017!

Tired of faxing authorization requests and medical records? Spending too much time on hold waiting to speak to an Authorization Specialist for non-urgent authorization request? Looking for a faster, more efficient way to submit authorizations? Why not submit your authorizations request through Clear Coverage? What are the benefits? Easy to access 24/7 online access to Clear Coverage Receive real time authorization status by viewing your office’s home page in Clear Coverage Services are immediately uploaded into Texas Children’s Health Plan’s authorization for clinical review Automatic APPROVALS may be...

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17May

Provider Alert! Authorization Extension for STAR Kids Members

Attention STAR Kids Providers May 17, 2017 Authorization Extension for STAR Kids Members The Health and Human Services Commission expects managed care organizations to extend long term services and supports (such as Personal Care Services, Community First Choice, and Private Duty Nursing) authorizations for services until completion of the STAR Kids Screening and Assessment Instrument (SAI), but no longer than July 1, 2017. In order to receive payment for these services, you must have authorization from Texas Children’s Health Plan, and the SAI must be completed by...

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03May

Verify Eligibility Monthly

As a reminder, members who have STAR and STAR Kids may change their managed care plans monthly. Providers should routinely verify eligibility with Texas Children’s Health Plan for membership by visiting our Texas Children’s Health Plan Provider portal at www.tchp.us\providers. The Provider portal has the most current information specific to Texas Children’s Health Plan. If you have questions regarding the Provider portal, please contact Texas Children’s Health Plan Provider Relations at 800-731-8527.

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02May

Provider Portal Access and Use

Each provider office is assigned an office manager for the purpose of managing the Texas Children’s Health Plan Provider portal. The office manager role is to ensure new staff who need access are assigned the correct security role, as well as to remove any employee who no longer needs access. As a reminder, the responsibility for protecting the HIPAA information within the Texas Children’s Health Plan Provider portal is solely held by each office. Office managers who need assistance with adding...

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Provider Alert!
01May

Need Help Navigating Pharmacy Prior Authorizations?

Pharmacy Prior Authorizations (PAs) can be a difficult administrative burden for providers and staff, however, they help ensure patients are receiving the most evidence-based, cost-effective medications. The Vendor Drug Program (VDP) is the state resource for the Texas Medicaid formulary and Preferred Drug List (PDL).  VDP has provided a very helpful guide to managing pharmacy benefits for your patients. You can access this resource here: http://casestudies.txhealthsteps.com/stepsQuickCourses/prescribers/ This Quick Course reviews the following: Searching Formulary for prescription and OTC drugs Checking the Preferred Drug List...

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07Apr

Inpatient Authorization Requests through Clear Coverage

Texas Children’s Health Plan is excited to announce the upcoming implementation of Clear Coverage for inpatient authorization requests beginning May 1, 2017. Clear Coverage is a web-based system that provides an automated method for providers and health plans to manage authorizations for inpatient services at the point of decision. Clear Coverage enables automated authorization, notification, eligibility and direction of members to in-network service providers. Clear Coverage provides the following benefits: Providers have immediate access to coverage, medical appropriateness and network rules,...

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Provider Alert!
23Mar

Provider Alert! Prior Authorization Changes Coming

Attention: All TCHP Providers Subject: TCHP Prior Authorizations TCHP will be updating the services requiring a prior authorization effective April 1, 2017. Please note there are some key changes to make providers aware of. Physical Therapy, Occupational Therapy and Speech Therapy re-evaluations will no longer need to be prior authorized. The CPT codes for these services are: 97164, 97168, S9152 Spinraza(Nusinersen) has been added as a Medical Benefit by TMHP. Spinraza(Nusinersen) will require a prior authorization. TCHP will follow TMHP coding guidance located at http://www.tmhp.com/News_Items/2017/03-Mar/03-03-%2017%20Billing%20Process%20Reminder%20for%20Spinraza%20nusinersen.pdf A new TCHP prior...

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15Mar

Meet Our New President

Lou Fragoso has been appointed president of Texas Children’s Health plan. He joined Texas Children’s Pediatrics in February 2014 and was vice president of Business Operations. Prior to joining Texas Children’s, Lou was in leadership roles at Baylor College of Medicine in Houston and at Lurie Children’s Hospital in Chicago. Lou is a Certified Public Accountant with over 20 years of healthcare finance and management experience. Since joining Texas Children’s Pediatrics, Lou spearheaded the creation of Texas Children’s Urgent Care. Texas...

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