Provider Alert

Articles with information about Provider Alerts.

Provider Alert!

Provider Alert! TCHP Fax Lines Availability: Fax lines open 24/7

Date: January 16, 2020 Attention: TCHP Providers Effective Date: January 6, 2020 Call to action: We are excited to announce that Texas Children’s Health Plan has made updates to the availability of the fax lines for authorization requests. The following outlines a summary of the changes. Beginning January 6, 2020, TCHP fax lines are open to receive requests for authorizations 24/7. This is a change to the former procedure to receive faxed requests for authorizations during normal business hours (Monday-Friday, 8a.m. – 6p.m.). Now [...]

Provider Alert!

Provider Alert! Update: Acute Therapy Requests with treatment for less than 60 days, a Texas Health Steps Checkup or Attestation is Not Required

Effective Date: October 31, 2019   Initial specialty therapy (occupational, physical, speech therapy) evaluations do not require prior authorization effective September 1, 2019. However, a current Texas Health Steps checkup performed in the last 12 months or a current well checkup attestation is required for ongoing specialty therapy lasting for greater than 60 days.   How this impacts providers: In an effort to ensure our in-network providers can provide specialty therapy evaluations within 21 days of submission of a signed referral, Texas Children’s [...]

Opioid Abuse CME

Texas Children’s Health Plan Is Offering Free Online Combating Opioid Abuse CME/CNE

Combating Opioid Abuse CME Series Provided by Texas Children’s Hospital and presented by Texas Children’s Health Plan. The Opioid Epidemic and SBIRT This course addresses the epidemiology of the opioid epidemic nationally and locally, as well as effective health care and public health responses. Tackling the Opioid Crisis; Effects on the Neonate Identify newborns at risk for NAS/NOWS, recognize the symptoms of NAS and discuss treatment options, and learn potential long-term sequelae of fetal exposure to opioids. Tackling the Opioid Crisis: An OB Perspective This class [...]

Provider Alert!

Provider Alert! Texas Department of State Health Services (DSHS) Laboratory Web Portal

On October 25th, it was reported that the laboratory web portal application for public health experienced unexpected technical difficulties. It is currently not available and as a result, the provider report cards are unavailable at this time. While DSHS Laboratory is actively working on a solution, there is not a date for when the matter will be resolved. How this impacts providers: Texas Health Step Providers that normally receive results via the Laboratory Web Portal will have the reports mailed [...]

Provider Alert!

Provider Alert! Acute Therapy Services

Acute Therapy Services Requests for acute occupational speech and physical therapy services will require documentation from the prescribing provider that a visit for the acute injury or acute exacerbation of the medical condition requiring therapy has occurred within the last 90 days. Acute speech therapy authorization will not require evidence of current Texas Health Steps well checkup for therapy treatment requests of 60 days or less. Therapy services for greater than 60 days will require evidence that the member is current in [...]

Provider Alert!

Provider Alert! Syphilis testing laws updated effective 9/1/2019

Texas law now mandates three syphilis tests for all pregnant women: at the first prenatal exam, during the third trimester (no earlier than 28 weeks gestation), and at delivery.  This new testing is required because congenital syphilis cases reported to the Texas Department of State Health Services (DSHS) more than doubled last year.  There were 367 cases of congenital syphilis in Texas in 2018, up from 164 in 2017. The increase in reported cases is likely due to a [...]

Provider Alert!

Provider Alert! Reimbursement Rate Changes for PCS, PDN & Therapy Services

Date: October 16, 2019 Attention: Home Health, Therapy and LTSS Providers Subject: Reimbursement Rate Changes for PCS, PDN & Therapy Services Effective Date: September 1, 2019 Call to action: On August 28, 2019, Texas Children’s Health Plan (TCHP) received notice of the rate changes from Texas Medicaid Healthcare Partnership (TMHP) effective September 1, 2019.  The services impacted by the Medicaid-implemented rate changes include: Personal Care Services (PCS) Private Duty Nursing (PDN) Therapies for Children in the Home Therapy Assistants TCHP is in the process of implementing the updates [...]

Provider Alert!

Provider Alert! Correction for new claim requirement

Effective October 1, 2019, all claims submitted to Texas Children’s Health Plan must be submitted with the member’s state provided Medicaid Identification Number and date of birth on the claim. Providers should confirm the Medicaid Identification Number is submitted in block {1a} for CMS-1500 forms and block {60} of a CMS 1450 (UB-04). For electronic claims, the member Medicaid Identification Number should be submitted in Loop 2010BA for either the 837P or 837I.The member’s date of birth must also be [...]

Provider Alert!

Provider Alert! Physician services provided in outpatient hospital settings

Effective October 1, 2019, physician services furnished in outpatient hospital settings that are ordinarily provided in a physician office will be reimbursed at a rate of 60% of the Texas Medicaid rate as outlined in Section 9.5.3 Reimbursement of the Texas Medicaid Provider Procedures Manual (TMPPM). Providers should verify impacted procedures and Place of Service (POS) codes to determine appropriate payment for covered services. The applicable procedure codes for those services include, but are not limited to: 99201-99205, 99211-99215, and [...]