Primary Care Providers

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

Zantac/ranitidine drug recalls due to NDMA impurity

Multiple drug manufacturers have issued voluntary drug recalls for several Zantac drug products and its generic, ranitidine. Ranitidine is a histamine-2 receptor antagonist used to treat heartburn and related conditions. Potentially impacted customers are being notified with a recommendation to stop taking the medication and to discuss alternative therapies with their provider. The recalls are due to discovery of an impurity (N-nitrosodimethylamine [NDMA]) in the finished product. NDMA is classified as a probable human carcinogen that may be found in [...]

The Flu and Antiviral Medications

Flu season is here and Texas Children’s Health Plan hopes everyone has received their flu vaccine. If you haven’t gotten your flu vaccine, it’s not too late! When you diagnose a patient with the flu, it’s important to understand when you can treat with antivirals, as well as which antiviral medications are approved and recommended for treatment each flu season. Antiviral medications work best if started within two days of getting sick with the flu. There are currently three antiviral medications [...]

Provider Alert!

Provider Alert! Texas Department of State Health Services (DSHS) Laboratory Web Portal

On October 25th, it was reported that the laboratory web portal application for public health experienced unexpected technical difficulties. It is currently not available and as a result, the provider report cards are unavailable at this time. While DSHS Laboratory is actively working on a solution, there is not a date for when the matter will be resolved. How this impacts providers: Texas Health Step Providers that normally receive results via the Laboratory Web Portal will have the reports mailed [...]

Provider Alert!

Provider Alert! Acute Therapy Services

Acute Therapy Services Requests for acute occupational speech and physical therapy services will require documentation from the prescribing provider that a visit for the acute injury or acute exacerbation of the medical condition requiring therapy has occurred within the last 90 days. Acute speech therapy authorization will not require evidence of current Texas Health Steps well checkup for therapy treatment requests of 60 days or less. Therapy services for greater than 60 days will require evidence that the member is current in [...]

Provider Alert!

Provider Alert! Syphilis testing laws updated effective 9/1/2019

Texas law now mandates three syphilis tests for all pregnant women: at the first prenatal exam, during the third trimester (no earlier than 28 weeks gestation), and at delivery.  This new testing is required because congenital syphilis cases reported to the Texas Department of State Health Services (DSHS) more than doubled last year.  There were 367 cases of congenital syphilis in Texas in 2018, up from 164 in 2017. The increase in reported cases is likely due to a [...]

Provider Alert!

Provider Alert! Dental Varnish Services

Date: October 16, 2019 Attention: Primary Care Providers Subject: Dental Varnish Services Call to action: Texas Children’s Health Plan (TCHP) identified an error in the reimbursement of dental varnish services.  This error may have resulted in non-payment of this service during a medical checkup for TCHP members who are 6 to 35 months of age.  An update to TCHP’s claims payment system is currently in process and all impacted claims will be reviewed and reprocessed for payment within the next 30 days. How [...]

Provider Alert!

Provider Alert! Reimbursement Rate Changes for PCS, PDN & Therapy Services

Date: October 16, 2019 Attention: Home Health, Therapy and LTSS Providers Subject: Reimbursement Rate Changes for PCS, PDN & Therapy Services Effective Date: September 1, 2019 Call to action: On August 28, 2019, Texas Children’s Health Plan (TCHP) received notice of the rate changes from Texas Medicaid Healthcare Partnership (TMHP) effective September 1, 2019.  The services impacted by the Medicaid-implemented rate changes include: Personal Care Services (PCS) Private Duty Nursing (PDN) Therapies for Children in the Home Therapy Assistants TCHP is in the process of implementing the updates [...]

Flu protection starts now

Influenza vaccines are available free-of-charge to enrolled providers through the Texas Vaccines for Children (TVFC) program for STAR, STAR Kids, and CHIP members birth through 18 years of age. Remind your Texas Children’s Health Plan patients that the influenza vaccine is a covered benefit. Texas Children’s Health Plan members who are age 7 years and older can also receive the influenza vaccine at a participating pharmacy. Click here for a list of pharmacies.


Understand your patients’ care gaps and improve your quality of care with the Inovalon HEDIS® Metrics Tool

Texas Children’s Health Plan PCPs and OB/GYN providers can now access data via the Inovalon HEDIS Metrics Tool through our Provider Portal. This new tool allows you to use performance and patient data so that you can independently manage your patient population, as well as improve the quality of disease management throughout your panel. Key features such as member-level gap reports and detailed HEDIS quality rates contribute to improving your provider incentive program rates. If you have any questions about [...]

Provider Alert!

Provider Alert! DME/equipment/supplies exceeding Texas Medicaid Limitations

Effective October 1, 2019, Texas Children’s Health Plan will implement a prior authorization process for providers to request prior approval to provide DME/Equipment/Supplies to members 20 years of age and under in excess of benefit limitations. Texas Children’s Health Plan applies benefit limitations for DME/Equipment/Supplies in accordance with the Texas Medicaid Provider Procedure Manual (TMPPM) for all members eligible to receive the benefit, except for the following:   Next steps for providers: DME/Equipment/Supplies for a member who is 20 years of age or [...]