Primary Care Providers

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

Provider Alert!

Provider Alert! Reimbursement Rate Changes and Updates for Texas Medicaid Procedure Code 90461

Date: November 22, 2022 Attention: All Providers                 Subject: Effective date: September 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 make providers aware that the physician administered drug vaccines and toxoids administration procedure code [...]

Provider Alert! COVID-19 Vaccine Administration Procedure Codes 0144A and 0154A Are Now Benefits; Age Range Updated for Procedure Code 0134A

Date: November 10, 2022 Attention: All Providers Effective date: October 12, 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 effective for dates of service on or after October 12, 2022, in accordance with [...]

Provider Alert! COVID-19 Disaster Declaration – ALERT #5 – Prior Authorization Adjustments

Date: November 21, 2022 Attention: All Providers Effective Date: October 25, 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: In response to the COVID-19 Disaster Declaration and in accordance with Texas Health and Human Services Commission, Texas Children’s Health Plan (TCHP) extends the following [...]

Provider Alert!

Provider Alert! Telemedicine/Telehealth claims guidance

Date: November 21, 2022 Attention: All Providers Effective Date: October 25, 2022 Federally Qualified Health Centers (FQHC) reimbursement for Telemedicine (Physician Delivered) and Telehealth (Non-Physician Delivered) Services as a distant site provider as permanent policy change (per S.B. 670, Texas Legislature, Regular session 2019) ended November 30, 2020 as announced by the Health and Human Services Commission. The content in this message on Rural Health Clinics as telehealth and telemedicine sites will remain in effect through March 31, 2022 as announced by the [...]

Provider Alert! COVID-19 UPDATE ALERT #4 – Telemedicine Services – Physicians, BH, FQHC and RHC Providers

Date: November 21, 2022 Attention: All providers Effective Date: October 25, 2022    The content in this message on Federally Qualified Health Centers (FQHC) reimbursement for Telemedicine (Physician Delivered) and Telehealth (Non-Physician Delivered) Services as a distant site provider as permanent policy change (per S.B. 670, Texas Legislature, Regular session 2019) ended November 30, 2020 as announced by the Health and Human Services Commission. The content in this message on Rural Health Clinics as telehealth and telemedicine sites will remain in effect through [...]

Provider Alert! Guidance on Appeals and Fair Hearing Requests due to COVID-19

Date: November 21, 2022 Attention: All providers Subject: Effective Date: October 25, 2022 The content in this message will remain in effect through November 30, 2022 as announced by the Health and Human Services Commission (HHSC). TCHP COVID-19 Utilization Management Procedure and provider alerts can be found here: http://www.thecheckup.org/provider-alerts/ Providers should monitor the Texas Children’s Health Plan 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 [...]

Provider Alert!

Provider Alert! Former Provider Portal Health Trio will not be Accessible after December 31, 2022

Date: November 18, 2022 Attention: All Providers 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: The purpose of this communication is to inform our network providers that the former provider portal platform, Health Trio, will no longer be accessible after December 31, 2022. How [...]

Provider Alert!

Provider Alert! This season a flu vaccine is more important than ever.

Attention Primary Care Providers: Flu season is upon us, and while it is not possible to say what will happen this winter, the Center for Disease Control (CDC) believes we might have an early and possibly severe season due to reduced population immunity. For this reason, it’s important we vaccinate ourselves and our patients to avoid serious complications from the flu and to prevent unnecessary medical visits and hospitalizations, which further strain the healthcare system.  Every person 6 months and older should [...]

Provider Alert!

Provider Alert! CGRP Antagonists- Prophylaxis, Prior Authorization Revision Scheduled for November 22, 2022

Date: November 14, 2022 Attention: Providers Effective Date: November 22, 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) will revise clinical prior authorization (PA) criteria for calcitonin gene-related peptide (CGRP) Antagonists-Prophylaxis. TCHP will separate renewal criteria from the initiation [...]

Provider Alert!

Provider Alert! Annual Review of Clinical Prior Authorization Criteria Guides

Date: November 14, 2022 Attention: Providers Effective date: November 29, 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) will revise the following clinical prior authorization criteria: Epidiolex, GLP-1 Receptor Agonists, Lovaza & Vascepa by November 29, 2022. The changes [...]