Provider Alert

Articles with information about Provider Alerts.

Provider Alert! Follow-up on Billing Provider Taxonomy Claims Requirement Effective September 1, 2018

Clearing House Process Verification: Please verify with your clearing house that the TMHP attested billing provider taxonomy is being transmitted on claims for all products. Through collaborative work with provider groups, it has been identified that some clearing houses have been removing the billing taxonomy code on claims prior to submitting to the health plan for processing resulting in claims denials. Billing provider taxonomy is a requirement effective 9/1/2018. Because providers use a variety of clearing houses for claims submission, your [...]

Provider Alert! TCHP Prior Authorization Requirement

Effective January 1, 2019, TCHP will be updating the prior authorization listing. Please note there are some key changes for providers. Removed from the list and will no longer require prior authorization: Baclofen Pump New to the list: Home Telemonitoring Updates: Ambulance (non-emergent transport) has been updated to Non-Emergency Ambulance Transport. Augmentative Communication Device has been updated to Augmentative Communication Device and Accessories. Chemotherapy non-FDA approved has been updated to Non-FDA approved medications. Cranial Molding Orthosis (Helmets) has been updated to Cranial Molding Orthosis. High cost (>$50,000) injectable in the [...]

Authorization and Verification Process Updates

Authorization and Verification Process Updates                                   Texas Children’s Health Plan has made updates to the authorization process. Individual Member Fax Requests To ensure Health Insurance Portability and Accountability Act (HIPAA) compliance, providers must send one fax request per member with each fax having its own cover sheet. Requests received with multiple members per fax will be returned to the provider and not processed. Minimum Information Required to Process a Request Providers must use the Texas Standard Prior Authorization Request Form*, which can be found [...]

Provider Alert! STAR Kids Billing Requirements

Attention: STAR Kids Providers REMINDER: STAR Kids Billing Requirements   As previously communicated, Texas Children’s Health Plan (TCHP) requires all STAR Kids providers billing for private duty nursing (PDN) services with the T1000 CPT code to use the billing matrix available on the Texas Health and Human Services website at https://hhs.texas.gov/laws-regulations/handbooks/star-kids-handbook/appendices/appendix-iii-ltss-billing-matrix-crosswalk. This requirement was effective June 5, 2017.   Failure to use this billing matrix, including placement of modifiers, will result in denials for incorrectly billed services.  Providers may receive line denials if [...]

Provider Alert! Reminder – LTSS Enrollment Deadline Extended to October 31, 2018

Attention:  Long Term Services and Supports Providers (LTSS) Subject:  Reminder - Enrollment Deadline Extended to October 31, 2018   This is a reminder that the enrollment deadline for Long Term Support Services (LTSS) providers serving MCO members is quickly approaching. Long Term Support Services (LTSS) providers serving MCO members are required to enroll through the Medicaid MCO LTSS provider enrollment process.   To allow sufficient time for application processing, MCO LTSS providers are strongly advised to submit applications as soon as possible.   An MCO LTSS [...]

Provider Alert! Texas Children’s Health Plan Claim Editing System Update

Attention:  All Providers Subject: Texas Children’s Health Plan Claim Editing System Update Effective: 12/27/2018   Texas Children’s Health Plan intends to transition to a new Claims Editing System (CES) by Optum on 12/27/2018. Please be aware that claims submitted prior to 12/27/2018 will continue to be processed by our current vendor, McKesson Claim Check. TCHP is required by Texas Health and Human Services to ensure all required claims edits are consistently applied. Migrating to Optum CES will enable TCHP to efficiently apply all required [...]

Provider Alert! Neonatal Level of Care Designation Updates

Date: August 28, 2018 Attention:  All Hospitals  Subject:  Neonatal Level of Care Designation Updates Effective for dates of service on or after September 1, 2018, hospitals enrolled in Texas Medicaid may be reimbursed for inpatient neonatal services only if the hospitals have received a neonatal level of care designation from the Department of State Health Services (DSHS) in accordance with 25 Texas Administrative Code §§133.181-133.190. Requirements: Hospitals with neonatal units must have a level of care designation.  Information on these requirements and an application [...]

Provider Alert! Nutritional Supplement Guideline Change

Effective 10/1/2018, Texas Children’s Health Plan will no longer require prior authorization for nutritional products for members 20 years and younger who: receive all or part of their nutritional intake through a tube as documented by ICD-10 codes (z43.1; z93.1, z93.4), OR have a metabolic disorder that has been documented with one of the diagnosis codes listed in the current TMPPM Section 2.2.17.2.2. Providers will retain the responsibility of maintaining appropriate documentation for the nutritional products supplied. A retrospective review may be [...]

Provider Alert! Authorization and Verification Process Updates

Subject:   Authorization and Verification Process Updates   Texas Children’s Health Plan (TCHP) has made updates to the authorization process. The following outlines a summary of the changes.   Individual Member Fax Requests To ensure Health Insurance Portability and Accountability Act (HIPAA) compliance, providers must send one fax request per member with each fax having its own cover sheet. Requests received with multiple members per fax will be returned to the provider and not processed.   Minimum Information Required to Process a Request *Providers must use the Texas Standard [...]

Provider Alert! New Claims Requirements Effective September 1, 2018

Date: August 20, 2018 New Claims Requirements Effective September 1, 2018 Attention:  Network Providers   Billing taxonomy Per section 6.2.1 of the TMPPM Billing providers must submit the taxonomy number on all electronic claims with the exception of Medicare primary claims. Electronic claims without a billing taxonomy will be rejected.   Claim Requirement Electronic Claim Billing Provider Taxonomy Code (required on all claims) 2000A, PRV03   Ordering/Referring Provider Requirement For services that require an ordering/referring provider the NPI of the ordering/referring provider must be attested. Billing providers can verify an ordering/ [...]