Primary Care Providers

Articles with relevant information for Primary Care Providers (PCP).
25Jun

Provider Alert! COVID-19/Pharmacy Revised Update from June 8, 2020

Attention: All Providers and Pharmacies Effective Date: June 24, 2020 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 Food and Drug Administration (FDA) has removed the emergency use authorization of hydroxychloroquine (HCQ) and chloroquine due to controlled studies showing no evidence of benefit for mortality...

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Provider Alert!
24Jun

Provider Alert! Prosthetics Codes Prior Authorization Requirements

Attention: Prosthetics, DME providers, orthopedists, podiatrists, PCPs Effective Date: June 3, 2020 Call to action: Texas Children’s Health Plan (TCHP) aligns with Texas Medicaid Provider Procedures Manual (TMPPM) and requires prior authorization for prosthetics procedures codes. How this impacts providers: Provider offices should utilize the Standard Prior Authorization Form for prosthetics. References: TCHP Prior Authorization Requirements TCHP Prosthetics Guidelines Next steps for providers: Providers should reference the prosthetic procedure codes according to TMPPM section 2.2.19.2 Prior Authorization and Documentation Requirements. If you have any questions, please email Provider Network...

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Provider Alert!
24Jun

Provider Alert! Prior Authorization guidelines for Manual Wheelchair Accessory Code E2227

Attention: All Providers Effective Date: June 23, 2020 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) aligns with the Texas Medicaid Provider Procedures Manual (TMPPM) regarding the authorization requirements for Code E2227, manual wheelchair accessory, and gear reduction drive wheel,...

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Provider Alert!
23Jun

Provider Alert! Authorization update for orthoses devices and related services

Attention: DME providers, orthopedists, podiatrists, PCPs Effective Date: September 5, 2020 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 the authorization requirements for custom fitted orthoses devices.  Certain prefabricated orthoses devices for acute injury...

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Provider Alert!
15Jun

Provider Alert! New Federal Enhanced Provider Relief Funds for Medicaid and CHIP Providers

Attention: All Providers Effective Date: June 10, 2020 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 you of new federal Enhanced Provider Relief Funds for Medicaid and CHIP providers. Here are the details: Beginning June 10, eligible...

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Provider Alert!
12Jun

Provider Alert! Positive Pressure Airway (PAP) device guideline

Attention: All Providers Effective Date: June 17, 2020 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: TCHP would like to inform you of recent updates to the guidelines for home health, speech therapy, and positive pressure airway (PAP) devices. Updates include the following: Home health guideline:...

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Provider Alert!
10Jun

Provider Alert! Update: Updates to Prior Authorization Requirements

Attention: All Providers Effective Date: June 4, 2020 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: TCHP would like to inform you of recent updates to the prior authorization requirements and the effective dates. Updates include the following:  Medical services now requiring prior authorizations:  Therapeutic Continuous Glucose Monitors-...

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Provider Alert!
10Jun

Provider Alert! COVID-19/Hydroxychloroquine Prescribing Revised Update from April 2, 2020

Attention: All Providers and Pharmacies Effective Date: June 9, 2020 Call to action: The Texas State Board of Pharmacy has modified the emergency basis rule when dispensing prescriptions for chloroquine, hydroxychloroquine, mefloquine, and azithromycin.  Physicians no longer have to include the diagnosis on the prescription. Additionally, the rule does not prevent a physician from prescribing one of these drugs for an off-label use.    How this impacts providers and pharmacies:  A diagnosis is no longer required to be provided on prescriptions for the above medications. Prescriptions may be written for off-label use.    Next...

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Provider Alert!
08Jun

Provider Alert! Nitrofurantoin Oral Suspension Drug Shortage

Attention: All Providers and Pharmacies Effective Date: June 12, 2020 Call to action: Drug shortages of nitrofurantoin oral suspension have been identified on the Medicaid and CHIP formularies.  There is only one National Drug Code (NDC) available on the market, and it is not on the Medicaid formulary. There are many other antibiotic choices available on the formulary and prescribers may choose an appropriate alternative based on patient diagnosis and indication for use. How this impacts providers:  Members may reach out to providers...

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Provider Alert!
08Jun

Provider Alert! Texas Medical Board Emergency Rule re: Issuance of Prescriptions During COVID-19 Pandemic

Attention: All Providers and Pharmacies Effective Date: June 12, 2020 Call to action: On June 5, 2020, the Texas Medical Board's (TMB) Executive Committee, with advice and direction from the Governor's Office, adopted rules on an emergency basis related to the issuance of certain prescriptions during the COVID-19 disaster. The emergency rule prohibits treatment of chronic pain with scheduled drugs through use of telemedicine medical services unless: i) a patient is an established chronic pain patient of the physician and is seeking telephone refill of an...

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