Primary Care Providers

Articles with relevant information for Primary Care Providers (PCP).
12Oct

Flu protection starts now

Influenza vaccines are available free-of-charge to enrolled providers through the Texas Vaccines for Children (TVFC) program for STAR, STAR Kids, and CHIP members birth through 18 years of age. Remind your Texas Children’s Health Plan patients that the influenza vaccine is a covered benefit. Texas Children’s Health Plan members who are age 7 years and older can also receive the influenza vaccine at a participating pharmacy. Click here for a list of pharmacies.

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Inovalon
07Oct

Understand your patients’ care gaps and improve your quality of care with the Inovalon HEDIS® Metrics Tool

Texas Children’s Health Plan PCPs and OB/GYN providers can now access data via the Inovalon HEDIS Metrics Tool through our Provider Portal. This new tool allows you to use performance and patient data so that you can independently manage your patient population, as well as improve the quality of disease management throughout your panel. Key features such as member-level gap reports and detailed HEDIS quality rates contribute to improving your provider incentive program rates. If you have any questions about Inovalon...

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Provider Alert!
01Oct

Provider Alert! DME/equipment/supplies exceeding Texas Medicaid Limitations

Effective October 1, 2019, Texas Children’s Health Plan will implement a prior authorization process for providers to request prior approval to provide DME/Equipment/Supplies to members 20 years of age and under in excess of benefit limitations. Texas Children’s Health Plan applies benefit limitations for DME/Equipment/Supplies in accordance with the Texas Medicaid Provider Procedure Manual (TMPPM) for all members eligible to receive the benefit, except for the following:   Next steps for providers: DME/Equipment/Supplies for a member who is 20 years of age or younger...

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21Sep

What does Service Coordination mean for your STAR Kids patients?

As a provider, you may have questions regarding the role Service Coordination plays in the lives of your STAR Kids patients. At Texas Children’s Health Plan, the goal of Service Coordination is to optimize health to ensure that the member’s tomorrow is better than his or her today. Service Coordination is a person-centered approach to care. Each of our members is assigned an appropriately licensed Service Coordinator. Our Service Coordinators are responsible for the following: Providing each member with initial and...

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10Sep

What is the Medically Dependent Children’s Program (MDCP) waiver?

If you have STAR Kids patients, there’s a chance some of them receive the Medically Dependent Children’s Program (MDCP) waiver, which is a home and community based services program. The goal of this program is to support families and children by preventing institutionalization and hospitalization, while helping them remain safely in their homes with the appropriate services. Examples of these services include: Flexible family support service Respite care Minor home modifications Adaptive aids Transition assistance services Employment assistance Supported employment Financial management services The purpose of enrolling a child...

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21Aug

UPDATE: Provider Portal/Health Effectiveness Data and Information Set (HEDIS)

We are still working on this portion of the Provider Portal project to bring you accurate, timely data so you can best manage your patients’ health. Please check our Provider Portal homepage for updates. Contact your provider relations manager to obtain your current HEDIS performance. Their contact information is available on our website, texaschildrenshealthplan.org on the For Providers page titled Meet our Team. It is also available on the Provider Portal at healthtrioconnect.com

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15Aug

No-cost sports and school physicals for CHIP and Medicaid patients

It’s back-to-school season, which means your patients will need to complete their annual sports and school physicals. As a value added service through our Healthy Rewards Program, CHIP and STAR patients ages 5 to 19 years and STAR Kids patients under 21 years can receive a no-cost sports and school physical if they have completed a Texas Health Steps or well-child visit within the last 12 months. Providers will be reimbursed for the cost of the sports and school physical. For...

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10Aug

Improving Access to SBIRT

Improving Access to Screening, Brief Intervention, and Referral to Treatment in Primary Care for Adolescents: A Resource Center From the Center for Health Care Strategies, Inc. (CHCS) Adolescence is often a period for risky behavior and experimentation with alcohol and drugs. An estimated 70 percent of high school students have tried alcohol and 49 percent of high school seniors have used an illegal drug at least once. As a population, adolescents are more vulnerable than adults are to addiction. Early identification of...

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07Aug

Appointment Availability Standards for Primary Care and OB

Appointment availability standards What are appointment availability standards? How do you as a provider with Texas Children’s Health Plan play a role? In 2015 Senate Bill 760 passed, requiring Texas Health and Human Services Commission (HHSC) to monitor the provider networks of managed care organizations. Texas Children’s Health Plan would like to ensure members are able to schedule appointments with providers in accordance with the HHSC’s appointment accessibility guidelines. AFTER HOURS: Primary Care Physicians who are accessible 24 hours a day, seven days...

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11Jul

Texas Children’s Health Plan increases yearly gastrostomy button (G-button) limits

A message from Dr. Katy Ostermaier, Medical Director of STAR Kids at Texas Children’s Health Plan Texas Children’s Health Plan is pleased to announce an increase in gastronomy button (G-button) limits per year. As of February 26, 2019, we now allow 6 G-buttons to be dispensed per year. Families who have children with G-buttons can have a hard time getting the supply of replacement G-buttons needed when they break. An active child may need to replace broken G-buttons often, but Texas Medicaid...

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