Primary Care Providers

Articles with relevant information for Primary Care Providers (PCP).
18Apr

Provider Alert! COVID-19 Vaccine Counseling Procedure Code G0315 Now a Benefit

Date: April 14, 2023 Attention: All Providers Effective Date: Dates of service on or after December 2, 2021 Call to action: Texas Children Health Plan (TCHP) would like to inform providers that effective for dates of service on or after December 2, 2021, COVID-19 vaccine counseling procedure code G0315 is a benefit of Medicaid for individuals birth through 20 years of age. How this impacts providers: Procedure code G0315 will be limited to once per day for the same provider, as well as three...

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

Provider Alert! Infant Well-Child Visits Reminder

Date: April 18, 2023 Attention: Primary Care Providers Call to action: Texas Children’s Health Plan (TCHP) encourages providers to ensure their infant patients are receiving timely well-child visits and immunizations, in compliance with the Texas Health Steps (THSteps) periodicity schedule. TCHP is committed to ensuring members recognize the importance of preventive care and is working with members to better understand and address member barriers to complying with the THSteps periodicity schedule. TCHP encourages providers to emphasize the importance of preventive care and...

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Provider Alert!
12Apr

Provider Alert! Livmarli Clinical Prior Authorization Criteria Revision Scheduled for May 30, 2023

Date: April 11, 2023 Attention: All Providers Effective Date: May 30, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective May 30, 2023, the Health and Human Services Commission (HHSC) will update prior authorization criteria for Livmarli that meets the recent FDA-approved age indication. How this impacts providers: Starting May 30, 2023, TCHP will expand the age requirement to pediatric patients three months and older. Next steps for providers: Prescribers should share this communication with their staff. Provider...

By Facilities, HHSC, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialists, , , 0 CommentsRead more...
Provider Alert!
12Apr

Provider Alert! Appealing Legacy Claims within our Provider Portal, Texas Children’s Link

Date: April 10, 2023 Attention: All Providers Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers utilizing Texas Children’s Link, our online provider portal, how to access and appeal legacy claims within this platform. Legacy Claims are defined as claims with a submission date prior to August 1, 2022.   Click here for the steps to access and appeal legacy claims. We hope this option improves your daily operations and makes the claims reconciliation process much easier. Background information: Texas...

By Facilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialists, , , 0 CommentsRead more...
Provider Alert!
11Apr

Provider Alert! FDA Withdrawal of Makena®

Date: April 10, 2023 Attention: All Providers Effective Date: April 06, 2023 Call to action: Effective April 6, 2023, the U.S. Food and Drug Administration (FDA) announced the final decision to withdraw the approval of Makena and its generics, which was approved to reduce the risk of preterm birth in women pregnant with one baby who have a history of spontaneous preterm birth. Makena and its generics are no longer FDA approved and cannot be lawfully distributed. This is in result due to...

By Facilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialists, , , , 0 CommentsRead more...
Provider Alert!
10Apr

Provider Alert! Clinical Criteria for Xenpozyme Procedure Code J0218 effective May 1, 2023

Date: April 6, 2023 Attention: All Providers Effective Date: May 1, 2023 Call to action: Effective May 1, 2023, the Health and Human Services Commission (HHSC) will begin the incorporation of prior authorization criteria for Xenpozyme (procedure code J0218) to the Enzyme Replacement Therapy policy. Xenpozyme is the first therapy indicated specifically for the treatment of non-central nervous system manifestations of acid sphingomyelinase deficiency (ASMD) in adult and pediatric patients, and is currently the only approved treatment for this disease. Authorization Requirements 1. Member has...

By Facilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialists, , , 0 CommentsRead more...
Provider Alert!
23Mar

Provider Alert! UPDATE: Recent Claim Denials Issued in Error are now Corrected

Date: March 23, 2023 Attention: All Providers Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that we have corrected the internal system error that was previously reported. The error impacted claims processing beginning February 27- March 7, 2023. All impacted claims from this time span have been reprocessed. The erroneous EOP message related to these claims was, “This Provider was not certified/eligible to be paid for this procedure/service on this date of service.” Claims impact report: Your assigned...

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

Provider Alert! Provider Enrollment Revalidation Extensions to End on May 11, 2023

Date: March 21, 2023 Attention: All Providers Call to action: Effective May 11, 2023, the Health and Human Services Commission (HHSC) will end the flexibility of extended Medicaid provider revalidation dates that came due during the COVID-19 public health emergency (PHE). How this impacts providers: Per federal guidance, providers that were due for revalidation effective March 1, 2020, through May 11, 2023, will receive a post-PHE grace period to complete the revalidation process. Texas Medicaid and Healthcare Partnership (TMHP) will notify providers in...

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22Mar

Provider Alert! HHSC Policy Flexibility for Member State Fair Hearings ends on May 11, 2023

Date: March 21, 2023 Attention: All Providers Call to action: The Health and Human Services Commission (HHSC) is ending the additional 30 days a member has to request a fair hearing starting May 12, 2023. For services provided up until May 11, 2023, Texas Children’s Health Plan (TCHP) will allow the additional 30 days. For services provided beginning May 12, 2023, and ongoing, the normal policy of allowing no less than 90 calendar days and no more than 120 calendar days from...

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22Mar

Provider Alert! Federal Public Health Emergency Set to End May 11, 2023 – Update on COVID Flexibilities

Date: March 21, 2023 Attention: All Providers Call to action:  The Health and Human Services Commission (HHSC) has received notice that the COVID-19 federal public health emergency (PHE) declared January 31, 2020, will end on May 11, 2023. In response to the PHE, HHSC implemented certain flexibilities for Texas Children’s Health Plan and other managed care organizations (MCOs) and dental maintenance organizations (DMOs), providers and members, and has issued guidance through MCO Notices with dates to reflect when that guidance is set...

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