Primary Care Providers

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

Provider Alert!
05Jan

Provider Alert! Prior Authorization Criteria Update for Amvuttra

Date: December 29, 2022 Attention: All Providers Effective date: February 1, 2023 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: Effective, February 1,2023, the Texas Health and Human Services Commission (HHSC) will update the prior authorization criteria for Amvuttra (procedure code J0225). Amvuttra (vutrisiran) is a transthyretin-directed...

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Provider Alert!
05Jan

Provider Alert! Medicaid Preferred Drug List and Formulary Changes

Date: December 29, 2022 Attention: Providers Effective Date: January 26, 2023 Call to action: Effective January 26, 2023, select medication(s) moved from “preferred” to “non-preferred” status and vice-versa. Texas Children’s Health Plan wants to notify providers so that these changes do not impact the ability of your STAR and STAR Kids members to obtain their medications.  A summary of the changes is included below. Resource: https://www.txvendordrug.com/formulary/preferred-drugs Changes with biggest impact to Texas Children Health Plan members and providers: MedicationTypePreferred alternativesCiproflaxacin suspension [G]AntibioticCipro suspension [B]E.E.S. (erythromycin) granules...

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Provider Alert!
28Dec

Provider Alert! Synagis Prior Authorization Guidance – Reminder

Date: December 28, 2022 Attention: All 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: Beginning with the 2022-23 Human Respiratory Syncytial Virus (RSV) season, the Texas Health and Human Services Commission (HHSC) implemented simplified approval criteria for Synagis subsequent dosing (renewals). Pharmacies will no...

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21Dec

Provider Alert! Genabio COVID-19 At-Home Test Kit Added to Formulary

Date: December 21, 2022 Attention: All Providers Effective date: November 21, 2022 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: Effective November 21, 2022, the Health and Human Services Commission (HHSC) added two new COVID-19 test kits are available as a reimbursable pharmacy benefit. Genabio is now...

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Provider Alert!
Provider Alert!
20Dec

Provider Alert! Hepatitis C Treatment Coverage and PDL Update Scheduled for January 1

Date: December 20, 2022 Attention: All Providers Effective date: January 1, 2023 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: On January 1, 2023, the Texas Health and Human Services Commission (HHSC) will designate one medication as the preferred direct-acting antiviral (DAA) drug option for treating...

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Provider Alert!
16Dec

Provider Alert! Correction to Rendering Provider Guidance Previously Provided

Date: December 16, 2022 Attention: All Providers   This communication is an update to the communication providedon November 23, 2022. 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: Please note this communication is a correction to the communication provided on November 23,2022. How this impacts providers: TCHP would...

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Provider Alert!
13Dec

Provider Alert! CHIP Coverage of Monkeypox Testing and Vaccines

Date: December 13, 2022 Attention: All Providers Effective date: Dates of service on or after July 26, 2022 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 Monkeypox testing and vaccines are a covered benefit in...

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12Dec

Provider Alert! Date: Guidance on Appeals and Fair Hearing Requests due to COVID-19

Date: November 30, 2022 Attention: All providers Effective Date: November 21, 2022 The content in this message will remain in effect through January 31, 2023 as announced by the Health and Human Services Commission (HHSC). TCHP COVID-19 Utilization Management Procedure and provider alerts can be found here: http://www.thecheckup.org/provider-alerts/ 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...

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Provider Alert!
08Dec

Provider Alert! Update: New Collaborative Care Model Medicaid Benefit; Attestation Form Now Available

Date: December 5, 2022 Attention: All Providers Effective Date for attestation form: January 1, 2023 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated with 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 remind providers that the Health and Human Services Commission (HHSC) has drafted a new Medicaid...

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Provider Alert!
06Dec

Provider Alert! EVV Home Health Care Services (HHCS)- Services Updates and Bill Codes Table Now Available

Date: November 30, 2022 Attention: STAR Kids Providers/Consumer Directed Services employers, and FMSA Providers The updates to the impacted services required to use EVV by January 1, 2024 (PDF) 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 share...

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