Provider Alert

Articles with information about Provider Alerts.

Provider Alert!

Provider Alert! 2021 Evaluation and Management (E/M) Guideline Changes

Attention:  All Providers Effective Date: January 1, 2021 Call to action: Evaluation and Management (E/M) Guidelines for new and established patient office visits and other outpatient services have gone through substantial revisions by the American Medical Association (AMA) and the Centers for Medicare & Medicaid Services (CMS). These changes are effective on January 1, 2021 and only affect the new and established patient office visits and outpatient codes (CPT 99201 – 99215). Code 99201 will be eliminated. The History and Physical Examination are no longer [...]

Provider Alert!

Provider Alert! Annual Electronic Visit Verification (EVV) Training Webinar

Attention: Current Electronic Visit Verification (EVV) Users Effective Date: 10/29/2020 Call to action: The webinar is for program providers currently required to use electronic visit verification by state law. Attending the webinar helps complete annual EVV policy and EVV Portal training requirements. There will also be a live question and answer session. The training is on November 13, 2020 at 8:30 a.m. – 12:30 p.m. How this impacts providers: Effective August 1, 2020, the Health and Human Services Commission (HHSC) Electronic Visit [...]

Provider Alert!

Provider Alert! Prior Authorization Guideline updates for TMJ and Skilled Nursing Facility

Attention: All Providers Effective Date: August 25, 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 recent updates to the prior authorization requirements and the effective dates. The following codes for each service [...]

Provider Alert!

Provider Alert! TCHP Psychotropic Medication Utilization Review (PMUR)

Attention: Pediatricians, Psychiatrists Call to action: Texas Children’s Health Plan (TCHP) utilizes a PMUR program to promote safe prescribing of behavioral health medications to children and adolescents.  TCHP identifies potential “prescribing outliers” using parameters established by the Texas Health and Human Services (HHSC).  This does not mean the prescribing is wrong or harmful to the child, but requires additional review due to potential for adverse reactions, polyprescribing, and other implications. Who is identified for review? Members under the age of 18 years [...]

Provider Alert!

Provider Alert! Subject: Codes: K0108, A9900, and E1399 Wheelchair Guideline

Attention: All Providers Effective Date: October 22, 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. In follow-up to our Provider Alert posted on 7/13/2020 regarding wheelchair accessories, Texas Children’s Health Plan did not implement changes to the current process for prior authorization of codes:  K0108, A9900, and [...]

Provider Alert!

Provider Alert! Texas Children’s Health Plan Special Investigations Unit and Claims Payment Review Information

Attention: All Providers Effective Date: October 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) would like to share information with our provider network on two important topics, the Special Investigation Unit and Claims Payment Reviews. What is the [...]

Provider Alert!

Provider Alert! Providers are encouraged to register to Administer COVID-19 Vaccine

Attention: Primary Care Providers 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 Department of State Health Services (DSHS) with urging physicians and medical facilities to enroll in the DSHS Immunization Program in order to receive doses [...]

Provider Alert!

Provider Alert! New prior authorization requirements for Teprotumumab-trbw (Tepezza)

Attention: Ophthalmologists and Endocrinologists Effective Date: January 19, 2021 Call to action: Texas Children’s Health Plan (TCHP) is aligning prior authorization criteria for teprotumumab-trbw (Tepezza), J3241 (formerly procedure code C9061), with the Texas Medicaid Provider Procedures Manual (TMPPM). Tepezza is a clinician administered drug indicated for members with thyroid eye disease (TED). Below are the new prior authorization criteria for TCHP members effective 1/19/2021. For initial therapy, ALL of the following criteria must be met: A diagnosis of Graves’ disease (diagnosis [...]

Provider Alert!

Provider Alert! October Webinars for Healthy Texas Women Plus

Attention: Primary Care and Obstetric Care Providers 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 invite network providers to webinars hosted by the Health and Human Services Commission (HHSC) promoting the new Healthy Texas Women [...]

Provider Alert!

Provider Alert! This season a flu vaccine is more important than ever

Attention: Primary Care Providers Flu season is upon us and while it’s not possible to say for certain what will happen this fall and winter, CDC believes it’s likely that flu viruses and the virus that causes COVID-19 will be spreading. For this reason, it’s more important than ever we vaccinate ourselves and our patients to avoid serious complications from the flu and to prevent unnecessary medical visits and hospitalizations, which further strain the healthcare system. Every person 6 months and [...]