Primary Care Providers

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

Provider Alert!
13Jan

Provider Alert! Date: Pneumococcal Vaccine Procedure Codes 90671 and 90677 Become Benefits of Texas Medicaid

Date: January 13, 2022 Attention: Primary Care Providers Effective Date: March 1, 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: The U.S. Food and Drug Administration (FDA) approved the use of PREVNAR 20 (procedure code 90677) on June 10, 2021 and the use of VAXNEUVANCE...

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06Jan

Provider Alert! COVID-19 At-home Test Kits Available as a Pharmacy Benefit

Date: January 4, 2022 Attention: All Providers Effective date: January 3, 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: HHSC will allow COVID-19 at-home test kits as a Medicaid and Children’s Health Insurance Program (CHIP) pharmacy benefit beginning January 3, 2022. Members may obtain COVID-19 at-home...

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06Jan

Provider Alert! Pfizer Oral COVID-19 Drug, Paxlovid, Added to Formulary

Date: January 5, 2022 Attention: All Providers Effective Date: December 27, 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: Health and Human Services Commission (HHSC) added Paxlovid to the Medicaid and Children’s Health Insurance Program (CHIP) formulary as a payable pharmacy benefit on December 27,...

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Provider Alert!
05Jan

Provider Alert! Texas Children’s Health Plan’s Cultural Competency Plan and Learning Opportunity

Date: January 3, 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: Texas Children’s Health Plan fosters an environment of diversity, equity and inclusion by providing the right resources for our network of providers to better serve our culturally diverse member population....

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Provider Alert!
28Dec

Provider Alert! Prior Authorization Criteria for Aduhelm

Date: December 28, 2021 Attention: All Providers Effective Date: January 1, 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: HHSC will add the drug Aduhelm (procedure code J0172) as of Jan. 1, 2022 and implement these criteria for fee-for-service Medicaid on Feb. 1, 2022. Key Details:...

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20Dec

Provider Alert! CHIP Perinatal Members Eligible for COVID-19 Vaccine

Date: December 20, 2021 Attention: All Providers Effective Date: December 11, 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: Effective December 11, 2020, CHIP Perinate members enrolled in CHIP Perinatal services are eligible to receive the COVID-19 vaccine. The CHIP Perinatal (CHIP-P) Program serves the...

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Provider Alert!
08Dec

Provider Alert! Clinical Prior Authorization Criteria Update for Repatha (evolocumab)

Date: December 7, 2021 Attention: Primary Care Providers Effective Date: December 6, 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 Medicaid will update the clinical prior authorization criteria for Repatha (evolocumab) to reflect the recent FDA-approved age expansion. How this impacts providers: Effective December 6,...

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Provider Alert!
08Dec

Provider Alert! Dupixent (dupilumab) Criteria Update

Date: December 7, 2021 Attention: Primary Care Providers and Pulmonologists Subject: Dupixent (dupilumab) Criteria Update Effective Date: October 20, 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: Effective October 20, 2021, Texas Medicaid revised criteria of the Dupixent (dupilumab).  Dupixent is FDA-approved as an add-on maintenance...

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Provider Alert!
08Dec

Provider Alert! Promethazine Update

Date: December 7, 2021 Attention: Primary Care Providers Effective Date: December 7, 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 Medicaid revised the Promethazine/Promethazine containing clinical prior authorization criteria by removing the Generic Code Numbers (GCN) for promethazine containing cough and cold products. Prior...

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Provider Alert!
29Nov

Provider Alert! Well Child and Texas Health Steps Visit reminder

Date: November 22, 2021 Attention: PCP, OB/GYN and Endocrinologist Providers Call to action: Texas Children’s Health Plan (TCHP) would like to remind you of the National Committee for Quality Assurance (NCQA) HEDIS Technical Specifications. How this impacts providers: Please submit all claims timely, as soon as services are rendered, and use appropriate codes to reflect the services provided particularly for Well-Care Visits and THSteps. Well-Child Visits in the First 30 Months of Life (W30) Two rates will be measured: Well-Child Visits in the First 15 Months: Six...

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