Primary Care Providers

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

Provider Alert! New Online Authorization Platform for Providers

Attention: All Providers Effective Date: January 1, 2021 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 providers that currently have access to Clear Coverage, our online authorization tool, that beginning January 1, 2021; [...]

Provider Alert!

Provider Alert! Medically Dependent Children Program Waiver (MDCP) Eligibility Process and Peer-to-Peer Review

Attention: Primary Care Providers and Sub Specialists  Effective Date: December 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: Per Texas Health and Human Services Commission (HHSC) contract changes effective December 1, 2020, Texas Children’s Health Plan (TCHP) would like to inform network [...]

Provider Alert!

Provider Alert! Updates to Prior Authorization Requirements for Genetic Testing, Wheelchair accessory, and Personal Care Services

Attention: All providers Effective Date: February 19, 2021 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 network providers of services that require a prior authorization effective February 19, 2021. Genetic Testing Codes: 81163 BRCA1 (BRCA1, DNA repair [...]

Provider Alert!

Provider Alert! Updates to Prior Authorization Requirements for CADs, electronic bone growth stimulators, home telemonitoring, and hospital beds

Attention: All providers Effective Date: February 19, 2021 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 network providers of Prior Authorization updates. Clinician Administered Drugs (CAD) that require a prior authorization effective February 19, 2021: 90378, [...]

Provider Alert!

Provider Alert! HHSC Texas Behavioral Health Services Survey

Attention: Behavioral Health Providers    Effective Date: Survey is available until November 21, 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 network Behavioral Health providers of a recent survey the Health and Human Services Commission [...]

Provider Alert!

Provider Alert! Telemonitoring Benefits Change for Texas Medicaid October 1, 2020

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 network providers of the recent telemonitoring benefits change for Texas Medicaid effective for dates of service on or after [...]

Provider Alert!

Provider Alert! HHSC COVID-19 Provider Impact Survey

Attention: All Providers Survey is open now until 5:00 PM on Tuesday, November 10, 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) encourages providers to complete the Health and Human Services Commission’s (HHSC) COVID-19 Impact Survey. Your participation [...]

Provider Alert!

Provider Alert! 2021 Evaluation and Management (E/M) Guideline Changes

Attention:  All Providers Effective Date: January 1, 2021 Call to action: Evaluation and Management (E/M) Guidelines for new and established patient office visits and other outpatient services have gone through substantial revisions by the American Medical Association (AMA) and the Centers for Medicare & Medicaid Services (CMS). These changes are effective on January 1, 2021 and only affect the new and established patient office visits and outpatient codes (CPT 99201 – 99215). Code 99201 will be eliminated. The History and Physical Examination are no longer [...]

Provider Alert!

Provider Alert! Annual Electronic Visit Verification (EVV) Training Webinar

Attention: Current Electronic Visit Verification (EVV) Users Effective Date: 10/29/2020 Call to action: The webinar is for program providers currently required to use electronic visit verification by state law. Attending the webinar helps complete annual EVV policy and EVV Portal training requirements. There will also be a live question and answer session. The training is on November 13, 2020 at 8:30 a.m. – 12:30 p.m. How this impacts providers: Effective August 1, 2020, the Health and Human Services Commission (HHSC) Electronic Visit [...]

Provider Alert!

Provider Alert! Prior Authorization Guideline updates for TMJ and Skilled Nursing Facility

Attention: All Providers Effective Date: August 25, 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 you of recent updates to the prior authorization requirements and the effective dates. The following codes for each service [...]