Provider Alert

Articles with information about Provider Alerts.

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 [...]

Provider Alert!

Provider Alert! DME/equipment/supplies exceeding Texas Medicaid Limitations

Effective October 1, 2019, Texas Children’s Health Plan will implement a prior authorization process for providers to request prior approval to provide DME/Equipment/Supplies to members 20 years of age and under in excess of benefit limitations. Texas Children’s Health Plan applies benefit limitations for DME/Equipment/Supplies in accordance with the Texas Medicaid Provider Procedure Manual (TMPPM) for all members eligible to receive the benefit, except for the following:   Next steps for providers: DME/Equipment/Supplies for a member who is 20 years of age or [...]

Provider Alert!

Provider Alert! Information for Members on Recent Storm

Dear Providers, The services you provide to our members are important and during this time of inclement weather, we want to make accessing health care as easy as possible. Please find important details to assist you below.  This information only applies to members located in the impacted counties as outlined. Impacted Counties:  Brazoria, Chambers, Galveston, Hardin, Harris, Jasper, Jefferson, Liberty, Matagorda, Montgomery, Newton, Orange, and San Jacinto Important Things to Know: Prior authorizations are waived for medically necessary procedures and treatments including service [...]

Provider Alert!

Provider Alert! Initial specialty therapy evaluations no longer require an authorization but do require current Texas Health Steps checkup or attestation

Date: September 19, 2019 Attention: All Providers Subject:  Amended:  Initial and Ongoing Specialty Therapy Treatment- Current Texas Health Steps Checkup or Attestation required Effective Date: September 19, 2019 Call to action: 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 [...]

Provider Alert!

Provider Alert! Reporting Provider Office Closures due to Recent Storm

Dear Providers, The severe weather experienced recently may have affected your ability to operate during normal business hours.  If you are unable to provide services to our members at this time, please contact us via the Provider Portal Message Center and select the “General Health Plan Questions” as the recipient.  Be sure to include any changes to your business hours and/or location and the TCHP Provider Network Management Department will follow-up with you. Thank you for your continued support and the [...]

Provider Alert!

Provider Alert! Smoking Cessation Benefits

Call to action: This notice is regarding the risk of severe lung disease among individuals who vape. Providers are reminded that screening and information on smoking cessation should be included as part of any routine patient visit.  In addition to the services and support available through CHIP and Medicaid Texas Children’s Health Plan offers value added smoking cessation benefits to its active members. How this impacts providers: Providers should educate susceptible patients presenting with respiratory symptoms or other related health [...]