Primary Care Providers

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

Provider Alert!
26Apr

Provider Alert! Change in Preferred Drug List Status for Antihyperuricemics Drug Class

Date: April 25, 2024 Attention: All Providers Effective date: April 22, 2024 Call to action: Effective April 22, 2024, the Texas Health and Human Services (HHS) removed non-preferred status from brand name Mitigare products. This is in response to the discontinuation of the brand products Colcrys by the manufacturer. The preferred status of the brand name Colcrys will not change to allow any remaining stock to be used. How this impacts providers: The change will allow providers to prescribe the generic without requiring PDL prior...

By OB/GYNs, Office Managers, Pharmacy, Primary Care Providers, Provider Alert, Specialists, , , 0 CommentsRead more...
Provider Alert!
18Apr

Provider Alert! Clinical Criteria Implementation for Enzyme Replacement Hormonal Therapy Agents effective May 1, 2024

Date: April 18, 2024 Attention: All Providers Effective Date: May 1, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective May 1, 2024, the Texas Health and Human Services (HHSC) will implement clinical prior authorizations to Adzynma (procedure code C9167) and Pombiliti (procedure code J1203) to the Enzyme Replacement Therapy (ERT) policy. Prior Authorization Requirements  Apadamtase alfa (Adzynma), procedure code C9167 is indicated to treat the following:  Pediatric and adult clients for prophylactic or on-demand ERT for congenital...

By OB/GYNs, Office Managers, Pharmacy, Primary Care Providers, Provider Alert, Specialists, , , 0 CommentsRead more...
Provider Alert!
04Apr

Provider Alert! New Prior Authorization Resource to Determine Dates of Service

Date: April 3, 2024 Attention: All Providers Call to action: The purpose of this communication is to inform providers of a new resource available from Texas Medicaid and Healthcare Partnership (TMHP) available at https://www.tmhp.com/topics/prior-authorization/pa-calculator.  It is included on the TMHP prior authorization webpage. Providers are encouraged to utilize this calculator to calculate the dates of service that must be applied to the prior authorization form/prior authorization request.  By accessing TMHP’s tool, providers will save time and avoid having to resubmit or correct authorizations...

By OB/GYNs, Office Managers, Pharmacy, Primary Care Providers, Provider Alert, Specialists, 0 CommentsRead more...
Provider Alert!
02Apr

Provider Alert! TCHP Member Transportation Vendor Update

Date: April 2, 2024 Attention: All Providers Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that our former Member medical transportation provider, Veyo has transitioned to Medical Transportation Management (MTM). MTM operates both Non-Emergent Medical Transportation (NEMT) and Value Added Services (VAS) rides for Members. Members or your staff will still call the same number to schedule rides, 1-888-401-0170. Best of all, the transportation benefits will remain the same. As a reminder, the process for members to schedule...

By OB/GYNs, Office Managers, Pharmacy, Primary Care Providers, Provider Alert, Specialists, , , 0 CommentsRead more...
Provider Alert!
26Mar

Provider Alert! New EVV Visit Transaction Rejection Codes to Begin April 1, 2024

Date: March 26, 2024 Attention: STAR Kids Providers/Consumer Directed Services employers and FMSA Providers Effective Date: April 1, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that beginning April 1, Electronic Visit Verification (EVV) visit transactions with dates of service on or after April 1, 2024, will receive new visit transaction rejection codes if the EVV Aggregator receives incomplete or incorrect data. Program providers and financial management services agencies (FMSAs) will see these new rejection codes in...

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Provider Alert!
26Mar

Provider Alert! Availity Now Offered to Providers for Electronic Claims Submission

Date: March 26, 2024 Attention: All Providers Effective Date: March 25, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to announce that Availity is now available as a clearinghouse option for electronic claims submissions. Getting Started with Availity: If a provider already uses Availity as a clearinghouse, then claims will route to TCHP payer IDs as normal (payer ID information can be found in the TCHP Institutional Guide and TCHP Professional Guide). No additional action is required. If a provider uses Change Healthcare...

By OB/GYNs, Office Managers, Pharmacy, Primary Care Providers, Provider Alert, Specialists, , , 0 CommentsRead more...
Provider Alert!
22Mar

Provider Alert! Change in PDL Status for Antivirals, Oral Drug Class

Date: March 22, 2024 Attention: All Providers Effective date: March 7, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective March 7, 2024, valganciclovir tablet will now be preferred along with brand Valcyte. This is in response to the shortage of the brand product Valcyte by the manufacturer. How this impacts providers: The change will allow providers to prescribe the generic without requiring preferred drug list (PDL) prior authorization at this time and continue accessing necessary...

By Facilities, HHSC, OB/GYNs, Office Managers, Pharmacy, Primary Care Providers, Provider Alert, Specialists, 0 CommentsRead more...
Provider Alert!
22Mar

Provider Alert! Sleep Studies no longer require Prior Authorization

Date: March 22, 2024 Attention: All Providers Effective date: February 7, 2024 Call to action: Effective for dates of service on or after February 7, 2024, Texas Children’s Health Plan (TCHP) will not require a prior authorization for sleep studies. Disclaimer: It is the responsibility of the Provider to verify that a service is a benefit of Texas Medicaid for service codes that TCHP does not require prior authorization. Services rendered by out-of-network providers will require prior authorization. TCHP would like to remind providers that...

By OB/GYNs, Office Managers, Pharmacy, Primary Care Providers, Provider Alert, Specialists, 0 CommentsRead more...
Provider Alert!
19Mar

Provider Alert! Annual HEDIS ® Medical Record Review Process has started

Date: March 19, 2024 Attention: Primary Care Providers Review Period: Now through April Call to action: TCHP would like to inform network providers that the HEDIS® medical record data review process began in February 2024 and will proceed through April 29, 2024. Additionally, we have contracted with Inovalon, Inc. to retrieve medical records and perform HEDIS® medical record data abstraction on our behalf. All medical records must be in to Inovalon by Monday, April 29, 2024. Please note the following: Inovalon serves as TCHP’s...

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Provider Alert!
18Mar

Provider Alert! Omnipod 5 Added to Medicaid and CHIP Formularies

Date: March 18, 2024 Attention: All Providers Effective date: February 22, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective February 22, 2024, the Texas Health and Human Services (HHSC) allows coverage for Omnipod 5 through pharmacy benefit for both CHIP and Medicaid formularies. Members can obtain one (1) Omnipod 5 G6 intro kit per 365 days, and fifteen (15) units of Omnipod 5 C6 PODS per 30 days. HHSC is not requiring clinical prior...

By OB/GYNs, Office Managers, Pharmacy, Primary Care Providers, Provider Alert, Specialists, , , 0 CommentsRead more...