Primary Care Providers

Articles with relevant information for Primary Care Providers (PCP).

Provider Alert! COVID-19 Vaccine Administration Procedure Codes 0074A and 0094A Is Now a Benefit of Medicaid and CHIP

table { border-collapse: collapse; }tr,td { border: solid thin; } Date: June 21, 2022 Attention: All Providers Effective Dates: 0094A on or after March 29, 2022 and 0074A on or after May 17, 2022 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event. TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event. TCHP will apply updates and reprocess impacted claims [...]

Provider Alert!

Provider Alert! Lorazepam Clinical Prior Authorization Update

table { border-collapse: collapse; }tr,td { border: solid thin; } Date: June 21, 2022 Attention: All Providers Effective Date: August 1, 2022 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event. TCHP will apply updates and reprocess impacted claims as soon as possible. However, please allow up to sixty (60) [...]

Provider Alert!

Provider Alert! Epidiolex Clinical Prior Authorization Criteria Update

Date: June 21, 2022 Attention: All Providers Effective Date: August 1, 2022 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event. TCHP will apply updates and reprocess impacted claims as soon as possible. However, please allow up to sixty (60) business days for reprocessing. Providers are not required to [...]

Provider Alert!

Provider Alert! Treatment Indications to Change for Ferric Carboxymaltose

Date: June 17, 2022 Attention: All Providers Effective Date: July 1, 2022 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event. TCHP will apply updates and reprocess impacted claims as soon as possible. However, please allow up to sixty (60) business days for reprocessing. Providers are not required to [...]

Provider Alert!

Provider Alert! Prior authorization criteria for Voxzogo (Vosoritide)

Date: June 15, 2022 Attention: All Providers Subject: Prior authorization criteria for Voxzogo (Vosoritide) Effective Date: July 15, 2022 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated with the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event. Call to action: Effective July 15, 2022, Texas Children’s Health Plan (TCHP) will implement the Voxzogo clinical edit in-line with the Health [...]

Provider Alert!

Provider Alert! Respiratory Syncytial Virus (RSV) Prophylaxis Season Reopening in All Regions

Date: June 15, 2022 Attention: All Providers Subject: Respiratory Syncytial Virus (RSV) Prophylaxis Season Reopening in All Regions Effective Date: June 1, 2022 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event. Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that the Health and Human Services [...]

Provider Alert!

Provider Alert! Prior Authorization Criteria Update for Aduhelm Begins July 1

Date: June 15, 2022 Attention: All Providers Subject: Prior Authorization Criteria Update for Aduhelm Begins July 1 Effective Date: July 1, 2022 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event. Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that the Health and Human Services [...]

Provider Alert!

Provider Alert! Vesta Windows Ends Aug. 31, 2022

Date: June 10, 2022 Attention: All Providers Effective Date: August 31, 2022 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated with the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event. Call to action: Texas Children’s Health Plan (TCHP) would like to notify program providers, Financial Management Services Agencies, and Consumer Directed Services employers using DataLogic Vesta Windows that [...]

Provider Alert! TMPPM Update for Monoclonal Antibodies Benralizumab, Mepolizumab, and Reslizumab

Date: May 24, 2022 Attention: All Providers Effective Date: April 1, 2022 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated with the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event. Call to action: Beginning April 1, 2022, Texas Medicaid & Healthcare Partnership (TMHP) will update the Texas Medicaid Provider Procedures Manual, Outpatient Drug Services Handbook section 7.57.5, “Prior Authorization for [...]

Provider Alert!

Provider Alert! Pfizer COVID-19 Vaccine Booster Dose for Children Update

Date: June 7, 2022 Attention: All Providers Effective Date: May 17, 2022 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated with the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event. Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that on May 17, 2022, the U.S. Food and Drug Administration (FDA) amended the emergency [...]