Pharmacy

Provider Alert!

Provider Alert! Update to Smallpox and Mpox Vaccine Reimbursement for Texas Medicaid

Date: July 12, 2024 Attention: All Providers Effective Date: August 1, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that for dates of service on or after May 1, 2024, the smallpox and mpox vaccine (procedure code 90611) may be reimbursed for the following provider types and places of service for clients who are 18 years of age or older: Place of ServiceProvider TypeOfficePhysicians, physician assistants, nurse practitioners, clinical nurse specialistsOutpatient hospitalHospital providers Effective August 1, 2024, for dates...

Provider Alert!

Provider Alert! Important Information on Checks Sent by Change Healthcare

Date: July 12, 2024 Attention: All Providers Texas Children’s Health Plan (TCHP) has just been notified that due to a process failure at Change Health Care (Change) a number of invalid checks have been erroneously issued. Change previously served as our payment processor. We transitioned our payment processing in February of this year in response to the cyber-security incident that caused Change to suspend services. These paper checks were erroneously issued to a number of our providers for amounts previously paid via check...

Provider Alert!

Provider Alert! Hurricane Beryl Guidance from the Texas State Board of Pharmacy

Date: July 11, 2024 Attention: Pharmacy providers Background: On Monday, July 8, Hurricane Beryl made landfall on the Texas coast, causing significant damage and flooding across numerous counties. This situation has forced many residents to evacuate to temporary locations. Call to action: In response to this emergency, the Texas State Board of Pharmacy has issued important guidance regarding emergency procedures. Pharmacists in Texas are authorized to dispense up to a 30-day supply of medication (excluding Schedule II controlled substances) for individuals affected by...

Provider Alert!

Provider Alert! Texas Children’s Health Plan Announces Partnership with Cotiviti

Date: June 24, 2024 Attention: All Providers Effective Date: October 1, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that beginning October 1, 2024, we will partner with Cotiviti, Inc (Cotiviti) for periodic post payment reviews of paid medical claims. The post payment reviews to be conducted are: Retrospective Clinical Claim Validation (RCCV) DRG, observation, and readmission reviews. These are the same/similar reviews that are currently being conducted, just with a new vendor, Cotiviti. What providers can expect: CCV...

Provider Alert!

Provider Alert! Co-pays for CHIP COVID-19 services will resume starting October 1, 2024

Date: June 21, 2024 Attention: All Providers Effective Date: October 1, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that beginning October 1, 2024, providers may begin collecting Children’s Health Insurance Program (CHIP) co-pays for COVID-19 related services. As you know, during the COVID-19 public health emergency, the Texas Health and Human Services Commission (HHSC) waived co-pays for COVID-19 vaccines, testing, and treatment for CHIP members. This waiver will end on September 30, 2024. Important reminders regarding co-payment for...

Provider Alert!

Provider Alert! Drugs Added to Medicaid, CHIP Formularies on June 6, 2024

Date: June 18, 2024 Attention: All Providers Effective date: June 6, 2024 Call to action: Texas Children’s Health Plan would like to inform providers that the Vendor Drug Program added the new drugs to the table available below, effective June 6, 2024. National Drug CodeDrug NamePDL Status62135099260ZIPRASIDONE HCL 40 MG CAPSULEPDL (preferred)62135099160ZIPRASIDONE HCL 20 MG CAPSULEPDL (preferred)62135099360ZIPRASIDONE HCL 60 MG CAPSULEPDL (preferred)62135099460ZIPRASIDONE HCL 80 MG CAPSULEPDL (preferred)62135004190FOSINOPRIL SODIUM 10 MG TABPDL (preferred)69097099205DILTIAZEM 24H ER(LA) 120 MG TBNPD (non-preferred)69097099305DILTIAZEM 24H ER(LA) 180 MG TBNPD (non-preferred)69097099405DILTIAZEM...

Provider Alert!

Provider Alert! You’re Invited to Our Provider Advisory Group!

Date: June 18, 2024 Attention: All Providers Event dates for the upcoming sessions Tuesday, September 24, 2024Tuesday, December 10, 2024All sessions will be from 12:00-1:30PM CST Call to action: Texas Children’s Health Plan (TCHP) invites you to join our quarterly Provider Advisory Group (PAG). We will hold our next session in September. We have updated the organization of the sessions. We will now hold one for all three Service Delivery Areas combined each quarter. Sessions will be held online as a Microsoft Teams...

Provider Alert!

Provider Alert! Texas Children’s Health Plan Highlights Patient Communication

Date: June 17, 2024 Attention: All Providers Call to action: Texas Children’s Health Plan (TCHP) would like to highlight the topic of patient communication this month with our providers. One aspect of patient communication, Motivational Interviewing, has been known to aid in promoting healthy habits and optimizing self-care. “Health coaching, its origin from motivational interviewing, enhances patient self-management of chronic conditions by improving patient compliance and outcomes, and reducing costs.” Source: https://pubmed.ncbi.nlm.nih.gov/19745624/ Background information: Based on the 2023 Experience of Care and Health...

Provider Alert!

Provider Alert! Maximum Allowable Update for Non-Risk Based Drugs Billed With ‘Unclassified’ Procedure Codes

Date: June 12, 2024 Attention: All Providers Call to action: The Texas Health and Human Services Commission (HHSC) would like to disclose the maximum allowable reimbursement for Non-Risk drugs currently payable under an ‘Unclassified’ procedure code as referenced in the National Drug Code to Healthcare Common Procedure Coding System (NDC to HCPCS) crosswalk. How this impacts providers: HHSC bases the pricing for an outpatient medical claim for an ‘Unclassified’ procedure code on the lesser of the manufacturer’s suggested retail price minus 18% or...

Provider Alert!

Provider Alert! Updates for Bone-Anchored Hearing Device (BAHD) Procedure Codes 92622 and 92623 for Texas Medicaid

Date: June 12, 2024 Attention: All Providers Effective Date: July 1, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that on July 1, 2024, the Texas Medicaid & Healthcare Partnership (TMHP) will update the Texas Medicaid Provider Procedures Manual (TMPPM), Vision and Hearing Services Handbook to move diagnostic analysis procedure codes 92622 and 92623 from section 3.2.1, “Cochlear Implants,” to section 3.2.3, “Bone-Anchored Hearing Device (BAHD).” Procedure codes 92622 and 92623 may be reimbursed for diagnostic analysis of the cochlear implant. Claims...