Primary Care Providers

Articles with relevant information for Primary Care Providers (PCP).
13Feb

What is the role of STAR Kids Service Coordinators?

A Service Coordinator is the central contact between Texas Children’s Health Plan and a member’s providers and family members. The purpose of a Service Coordinator is to maximize a Member’s health, wellbeing and independence. The Service Coordinator must work with the Member’s PCP to coordinate all of a member’s health services. The STAR Kids Service Coordinator also engages as an advocate and intervenes on behalf of the member if approved by the member. The Service Coordinator will perform an overall evaluation...

By Facilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialists, , , , , 0 CommentsRead more...
13Feb

AAP Strongly Advises Against Codeine for Children

The American Academy of Pediatrics (AAP) has recently released a Clinical Report strongly advising against codeine use in children. The rationale of the AAP is as follows: “Codeine is a prodrug with little inherent pharmacologic activity and must be metabolized in the liver into morphine, which is responsible for codeine’s analgesic effects. However, there is substantial genetic variability in the activity of the responsible hepatic enzyme, CYP2D6, and, as a consequence, individual patient response to codeine varies from no effect to...

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13Feb

Know When to Prescribe an Antiviral

Vaccination Flu season is back and vaccinating continues to be the best way to protect ourselves and our patients against serious complications from the flu.[1] Patients should only receive the intramuscular vaccine; intranasal flu vaccine is not effective for the 2016-2017 flu season.1 Patients 17 and younger should be offered the flu vaccine during office visits, while those 18 years and older also have the option of receiving it at pharmacies. Treatment (Antiviral and Supportive) Patients who are high risk for complications and...

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01Feb

HEDIS Spotlight: Prenatal / Postpartum Care

HEDIS stands for Healthcare Effectiveness Data and Information Set. It is a widely used set of performance measures by the nation’s health plans, and an essential tool in ensuring that our members are getting the best healthcare possible. It is extremely important that our providers understand the HEDIS® specifications and guidelines. In this section of The Checkup we will highlight different HEDIS metrics. We will provide a description of the measures, the correct billing codes to support services rendered and...

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17Jan

HHSC Notice! THSteps Documentation Improvement

Dear Texas Health Steps Provider: CHARLES SMITH EXECUTIVE COMMISSIONER As a Texas Health Steps (THSteps) provider, you affect the lives of many young Texans, and the Health and Human Services Commission (HHSC) understands documenting the THSteps components of the checkup can be challenging. One federal and two state contracted reviews of medical records have shown that missing documentation is the largest factor and the primary cause of records being reviewed and money being recouped. HHSC would like to assist you in documenting all...

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22Dec

Texas Children’s Health Plan’s Chief Medical Officer Named ACOG President-Elect

Houston—Lisa Hollier, MD, MPH, Chief Medical Officer for Obstetrics and Gynecology for Texas Children’s Health Plan and Medical Director for The Center for Children and Women, has been selected President-elect of the American College of Obstetrics and Gynecologists to serve the May 2017-May 2018 term. She will take office at the Executive Board Meeting on May 9, 2017. Hollier is also a professor of Obstetrics and Gynecology and director of the Division of Women’s Health Policy at Baylor College of Medicine....

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12Dec

Are you meeting access standards?

Primary care providers must be accessible to Texas Children’s Health Plan members 24 hours a day, 7 days a week. Acceptable after-hours coverage includes: The office telephone is answered after-hours by an answering service that meets language requirements of the major population groups and that can contact the PCP or another designated medical practitioner. All calls answered by an answering service must be returned within 30 minutes. The office telephone is answered after normal business hours by a recording in the language of...

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07Dec

Provider Alert! Health Advisory Issued on Mumps Outbreaks in Texas

The Texas Department of State Health Services issued a Health Advisory on 11/30/2016 due to two outbreaks of mumps in North Central Texas. An outbreak in Dallas County involves 5 adults and a Johnson City outbreak involves 10 cases, mostly in children. Several other outbreaks have occurred in the US outside of Texas. DSHS requests that physicians "please consider mumps as a diagnosis for any patients presenting with the following symptoms, particularly those who have traveled out of the state or have...

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25Oct

Upcoming Texas Children’s Health Plan Provider TouCHPoint portal changes: Provider Attestation required

The Texas Children’s Health Plan Provider portal is changing. In order to be compliant with HHSC guidelines to confirm provider demographic information, the Texas Children’s Health Plan Provider portal will require a quarterly attestation of information by NPI number. If access to the secure portal has been blocked because of needed attestation, users will not be able to access the portal until an office administrator for the account attests the information on file. Only staff with office administrator-level access can provide...

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