Primary Care Providers

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

Provider Alert!

Provider Alert! Attention: NCQA HEDIS Measure Changes

Attention: PCP, OB/GYN and Endocrinologist Providers Effective Date: January 1, 2020 Call to action: Texas Children’s Health Plan (TCHP) would like to inform you of changes to the National Committee for Quality Assurance (NCQA) HEDIS Technical Specifications released on July 1st, 2020. How this impacts providers: These changes are effective as of January 1, 2020. REVISED MEASURES Well-Child Visits in the First 30 Months of Life (W30) Revised the measure name and replaces the former W15 measure Added Age 15 Months - 30 Months Two rates will [...]

HEDIS Toolkit Offers Benefits to Providers

Members are cared for as HEDIS measures are met  Texas Children’s Health Plan developed a HEDIS Toolkit that contains helpful information regarding the measure requirements, standards and codes to use that are acceptable for HEDIS reporting. The new toolkit can be accessed here. This toolkit will serve as a reference form that can be used to code the type of appointments made and ensure that all of the HEDIS standards are met.  This will help providers maintain high quality care and [...]

Provider Alert!

Provider Alert! Screening and Coding for Social Determinants of Health

table { border-collapse: collapse; }tr,td { border: solid thin; } Attention: Primary Care and Obstetric Care 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: As stewards of our member’s care, Texas Children’s Health Plan (TCHP) would like to raise your awareness of [...]

Provider Alert!

Provider Alert! Guidance for Laxatives for Medicaid Members

table { border-collapse: collapse; }tr,td { border: solid thin; } Attention: All Providers Effective Date: September 3, 2020 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: Polyethylene Glycol [PEG] 3350 (generic for Miralax), ClearLax (powdered formulation of PEG 3350) and generic lactulose are all [...]

Provider Alert! Telehealth Services – PT/OT/ST Providers and COVID-19

Attention: All providers. Effective Date: April 10, 2020   Updated 9/9/2020 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 the evolving nature of the COVID-19 event. Call to action: Texas Children’s Health Plan (TCHP) supports the delivery of telehealth (non-physician-delivered) distant site services to its members, and we have implemented special waiver provisions for its use [...]

Provider Alert!

Provider Alert! Hurricane Laura Information for Medicaid Providers

Date: September 10, 2020 Attention: All Medicaid 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: Texas Children’s Health Plan (TCHP) would like to inform our network Medicaid providers of new guidance from the Health and Human Services Commission (HHSC) regarding coverage. Texas providers [...]

Provider Alert!

Provider Alert! Ambulatory and Long-Term Electroencephalogram Benefits Changing for Texas Medicaid

table { border-collapse: collapse; }tr,td { border: solid thin; } Attention: All Providers        Effective Date: October 1, 2020 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 [...]

Provider Alert!

Provider Alert! Irreparably Damaged DME Prosthetics, Orthotics, & Supplies during Hurricane Laura

Attention: DME Providers Date: September 9, 2020 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) aligns with the guidance from Health & Human Services Commission (HHSC) regarding replacement of durable medical equipment (DME) supplies that may have been destroyed or [...]

Provider Alert!

Provider Alert! Inhaled Glucocorticoids and Insulin Products Return to Non-Preferred for Medicaid Members

table { border-collapse: collapse; }tr,td { border: solid thin; } Attention: All Providers Effective Date: September 18, 2020 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: Beginning September 18, 2020 the Texas Vendor Drug Program (VDP) will restore non-preferred status to some of the inhaled glucocorticoids [...]

Provider Alert!

Provider Alert! 2020-21 RSV Season and Synagis (palivizumab)

Attention: All Providers Effective Date: September 24, 2020 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: Respiratory Syncytial Virus (RSV) season is here! The Texas RSV region schedule and map can be found on the Texas Health and Human Services (HHSC) Vendor Drug Program (VDP) [...]