Provider Alert

Articles with information about Provider Alerts.

Provider Alert!

Provider Alert! Omnipod 5 Added to Medicaid and CHIP Formularies

Date: March 18, 2024 Attention: All Providers Effective date: February 22, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective February 22, 2024, the Texas Health and Human Services (HHSC) allows coverage for Omnipod 5 through pharmacy benefit for both CHIP and Medicaid formularies. Members can obtain one (1) Omnipod 5 G6 intro kit per 365 days, and fifteen (15) units of Omnipod 5 C6 PODS per 30 days. HHSC is not requiring clinical prior...

Provider Alert!

Provider Alert! EVV Claims Matching Resumes April 1, 2024; Unmatched EVV Claims will Deny for Payment

Date: March 7, 2024 Attention: STAR Kids Providers/Consumer Directed Services employers and FMSA Providers Effective Date: April 1, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that Texas Health and Human Services Commission (HHSC) implemented a claim matching bypass on February 1, 2024 – for Electronic Visit Verification (EVV) claims with dates of service from January 1 through March 31 – to be paid without a matching EVV visit. EVV claims matching for all services required to use...

Provider Alert!

Provider Alert! Updates to HHAeXchange Training Resources

Date: March 4, 2024 Attention: EVV Program Providers and FMSAs Call to action: Texas Children’s Health Plan (TCHP) would like to make providers aware that HHAeXchange has updated its training resources available for Electronic Visit Verification (EVV) program providers and financial management services agencies (FMSAs) that use the HHAeXchange Portal as their EVV system. How this impacts providers: The updated training resources, located on the HHAeXchange webpage, include: HHAX Provider Portal FAQs (PDF) HHAX EVV Aggregation Transaction Manager Rule Holds and Resolutions (PDF) Next step for...

Provider Alert!

Provider Alert! Important Information for Checks Dated February 27, 2024

Date: March 4, 2024 Attention: All Providers Call to action: As noted in our Provider Alert dated February 26, 2024, Texas Children’s Health Plan (TCHP) has activated an alternative payment process that will be in effect until Optum’s Change Healthcare process is restored.  The referenced alert is available here. How this impacts providers: Errors have been identified in the checks dated and mailed February 27, 2024. Please do not deposit these checks and destroy them when received. Checks dated February 27, 2024 have...

Provider Alert!

Provider Alert! Texas Children’s® Link, Online Provider Portal Claim Submission Guidance

Date: March 1, 2024 Attention: All Providers Call to action: In response to Optum’s recent Change Healthcare network interruption, Texas Children’s Health Plan (TCHP) would like to provide details on the claim submission methods currently available. Where can providers submit claims: The most efficient option is submitting claims and appeals through Texas Children's® Link, our provider portal https://epiccarelink.texaschildrens.org/ The batch claim submission process is available on the portal, where 837 files can be uploaded directly onto Texas Children's® Link. To access this from Texas Children's® Link,...

Provider Alert!

Provider Alert! Notification of Observation/Treatment Room and E&M Services Reimbursement PolicyProvider Alert!

Date: February 29, 2024 Attention: Hospital facilities Effective Date: May 27, 2024 Call to action: The purpose of this communication is to make hospital facilities aware of a new reimbursement policy for Texas Children’s Health Plan (TCHP), which outlines the billing restrictions for observation and treatment room revenue codes billed with evaluation and management (E&M) services.  This policy applies to hospitals billing outpatient services, and applies to CHIP and Medicaid lines of business. How this impacts providers: Policy guidelines are as follows:Observation and treatment...

Provider Alert!

Provider Alert! Coverage of Elevidys Begins January 2024

Date: February 27, 2024 Attention: All Providers Prior authorization effective date: February 1, 2024 Call to action: The purpose of this communication is to inform providers that on January 1, 2024, Elevidys became a benefit of Medicaid and CHIP. Texas Health and Human Services Commission (HHSC) requires prior authorization for Elevidys (procedure code J1413) for Medicaid and CHIP, effective February 1, 2024. Elevidys is an adeno-associated virus vector-based gene therapy indicated for the treatment of ambulatory pediatric clients ages 4 through 5 years with...

Provider Alert!

Provider Alert! HCPCS and CPT Code Prior authorization Update

Date: February 26, 2024 Attention: All Providers Effective date: January 1, 2024 Call to action: The purpose of this communication is to offer information about the Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) prior authorization updates. Resource: https://www.tmhp.com/sites/default/files/file-library/resources/rate-and-code-updates/hcpcs-updates/2024-hcpcs-special-bulletin.pdf How this impacts providers: Effective January 1, 2024 Texas Children’s Health Plan’s (TCHP's) prior authorization updates are listed below. These changes follow guidance from Texas Medicaid and Healthcare Partnership (TMHP). Medical necessity criteria for utilization review will be in accordance with Texas Medicaid...

Provider Alert!

Provider Alert! Enzyme Replacement Therapy Prior Authorization Update

Date: February 26, 2024 Attention: All Providers Effective date: February 1, 2024 Call to action: Texas Children’s Health Plan would like to make providers aware of prior authorization updates for certain enzyme replacement therapies. In alignment with Texas Medicaid Provider Procedure Manual (TMPPM) requirements, effective for dates of service on or after February 1, 2024, prior authorization will be required for enzyme replacement therapy velmanse alfa-tycv (Lamzede), procedure code J0217, and pegunigalsidase alfa-iwxj (Elfabrio), procedure code J2508. Prior Authorization Requirements include the following: Velmanse alfa-tycv...

Provider Alert!

Provider Alert! Optum’s Change Healthcare Network Interruption Update: Payment Information

Attention: All Providers Date: February 26, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to provide an update regarding Optum’s recent Change Healthcare network interruption. In an effort to mitigate the financial impact to our providers, TCHP has activated an alternative payment process that will be in effect until Optum’s Change Healthcare process is restored.   Alternative payment information  Payments for claims received will be made via check until electronic funds transfer (EFT) is setup with our Accounts Payable department (please see...