Primary Care Providers

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

Provider Alert!

Provider Alert! Trikafta Age Expansion in Cystic Fibrosis Agents Clinical Prior Authorization Begins September 1

Date: July 8, 2021 Attention: Primary Care Providers and Pulmonologists Effective Date: September 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 will update the clinical prior authorization criteria for Trikafta (elexacaftor, tezacaftor, ivacaftor) to align with the FDA recent age...

Provider Alert!

Provider Alert! Reimbursement and Audit Notification on Surgical Procedure Codes (last updated July 1, 2021)

Date: July 1, 2021 Attention: All Providers Subject: 2021-2022 Reimbursement and Audit Notification on Surgical Procedure Codes (last updated July 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 provide information to providers that TCHP follows the...

Provider Alert!

Provider Alert! Vaxelis Vaccine Series to Become Available for Texas Medicaid

Date: June 30, 2021 Attention: Primary Care Providers Effective Date: July 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 providers of a new vaccine available for Medicaid Members. How this impacts providers: Vaxelis, a three-dose vaccine...

Provider Alert!

Provider Alert! Voluntary Recall Notice: Phillips Respironics Medical Devices

Date: June 29, 2021 Subject: Voluntary Recall Notice: Phillips Respironics Medical Devices 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 make providers aware of an important voluntary recall Philips Respironics has initiated for two of their ventilators...

Provider Alert!

Provider Alert! Nucala Clinical Prior Authorization Update

Date: June 29, 2021 Attention: Primary Care Providers and Pulmonologists Subject: Nucala Clinical Prior Authorization Update Effective Date: July 12, 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: The Health and Human Services Commission (HHSC) will update the clinical prior authorization criteria for Nucala in the...

Provider Alert!

Provider Alert! Speech, Physical, and Occupational Therapy Prior Authorization Update

Date: June 23, 2021 Attention: Therapy and Primary Care Providers Effective Date: June 23, 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 providers of updated TCHP prior authorization requirements. How this impacts providers: Effective June 23, 2021, the...

Provider Alert!

Provider Alert! Reminder: Targeted Case Management Code T1017 Requires Prior Authorization

Date: June 22, 2021 Attention: Primary Care Providers and Behavioral Health 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: As a reminder, Texas Children’s Health Plan (TCHP) requires a prior authorization for Targeted Case Management, Code T1017. How this impacts providers: Standard Prior Authorization Form Behavioral...

Provider Alert!

Provider Alert! Continuing Medical Education/Ethics: Neonatal Abstinence Syndrome Awareness Month resources and events

Date: June 18, 2021 Attention: All Obstetric Care Providers, Family Practice, PCPs, and Pediatric Providers Online courses are offered: June 15, 2021 – June 29, 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: In recognition of Neonatal Abstinence Syndrome (NAS) Awareness Month for the month...

Provider Alert!

Provider Alert! Webinar series: Several Aspects of HIV Prevention in Healthcare Settings

Date: June 11, 2021 Attention: Primary Care Providers, Emergency Care Providers, and others involved or interested in HIV prevention and care Webinar Dates: The events are held online from June 8 to July 14 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 Texas Collaborative for...

Provider Alert!

Provider Alert! Reimbursement Reminder for Outpatient Surgical Procedure Codes

Date: June 4, 2021 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 (TCHP) would like to provide information to providers that TCHP follows Health and Human Services Commission (HHSC) guidance for outpatient surgical procedure reimbursement. Payments for...