Provider Alert

Articles with information about Provider Alerts.

Provider Alert!
27Sep

Provider Alert! Clinical Criteria for Hemgenix® (procedure code J1411) effective November 1, 2023

Date: September 26, 2023 Attention: Physicians Effective date for prior authorization criteria: November 1, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective November 1 2023, the Texas Health and Human Services (HHSC) will be implementing prior authorization criteria for Hemgenix® (procedure code J1411) for fee-for-service Medicaid. Hemgenix (etranacogene dezaparvovec-drlb) is an adeno-associated virus vector-based gene therapy indicated to treat adult patients with Hemophilia B (congenital Factor IX deficiency). Prior Authorization Requirements: Coverage will be provided for...

By OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialists, , , , , 0 CommentsRead more...
Provider Alert!
26Sep

Provider Alert! Electronic Visit Verification Data Access and Conversion

Date: September 25, 2023 Attention: STAR Kids Providers/Consumer Directed Services employers, and FMSA Providers Call to action: This notice is for program providers, financial management services agencies (FMSAs) and Consumer Directed Services (CDS) employers transitioning to the new state-funded EVV vendor, HHAeXchange. All visits in the EVV Aggregator will continue to be available and accessible for program providers, FMSAs, and CDS employers. One year of historical accepted visits will be available in HHAeXchange as part of data conversion. This will be based on...

By OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialists, , , , , , 0 CommentsRead more...
Provider Alert!
22Sep

Provider Alert! Discontinuation of EVV Required Free Text Reviews

Date: September 22, 2023 Attention: STAR Kids Providers/Consumer Directed Services employers, and FMSA Providers Effective date: Immediately for dates of service beginning August 1, 2023 Background information: As you may know, as part of Electronic Visit Verification (EVV) compliance reviews, payers like Texas Children’s health Plan, review EVV visit transactions to determine if required free text is entered when using a reason code. Health and Human Services Commission (HHSC) is discontinuing required free text reviews of EVV visit transactions beginning with dates of services...

By OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialists, , , 0 CommentsRead more...
Provider Alert!
22Sep

Provider Alert! Registration Available for HHSC EVV Policy Training Webinars for Program Providers, FMSAs and CDS Employers

Date: September 21, 2023 Attention: STAR Kids Providers/Consumer Directed Services employers, and FMSA Providers Webinar dates: October 5 or 19 and November 2 Call to action: Texas Children’s Health Plan (TCHP) encourages provider’s attendance at the upcoming webinars hosted by Health and Human Services Commission (HHSC). This training will cover Electronic Visit Verification (EVV) policy training. The intended audience is program providers; financial management services agencies (FMSAs) and Consumer Directed Services (CDS) employers in order to complete the EVV Policy Handbook training requirement. Webinar...

By OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialists, , , , 0 CommentsRead more...
Provider Alert!
21Sep

Provider Alert! Correction to EVV Policy Updates Now Available for Alternative Devices

Date: September 21, 2023 Attention: STAR Kids Providers/Consumer Directed Services employers, and FMSA Providers Effective date: October 1, 2023 Call to action: The purpose of this communication is to correct what was previously published. Health and Human Services Commission (HHSC) sent a GovDelivery notice on September 13, 2023 for the new and revised Electronic Visit Verification (EVV) alternative device policy. Texas Children’s Health Plan (TCHP) published a provider alert upon receipt. Correction explanation: The correction is to state that qualified members using the Agency Option...

By Provider Alert, Specialists, , , 0 CommentsRead more...
Provider Alert!
21Sep

Provider Alert! Billing Updates for Envolve Vision

Date: September 19, 2023 Attention: All Providers Effective Date: October 1, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to remind you that Envolve Vision provides vision coverage for our CHIP, STAR and STAR Kids members up to 18 years old. For your awareness, Envolve Vision's Clinical Policy for Routine (Preventive) Eye Examination (OC.UM.CP.0013) has recently been updated. The following changes will take effect for claims submitted on or after October 1, 2023: Headache codes R51.0 and R51.9 have been removed from...

By Facilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialists, , 0 CommentsRead more...
Provider Alert!
13Sep

Provider Alert! EVV HHAeXchange Updates: Take Action Now and Onboard, EVV Systems AuthentiCare and Vesta and EVV Alternative Device PolicyProvider Alert!

Date: September 12, 2023 Attention: STAR Kids Providers/Consumer Directed Services employers, and FMSA Providers Call to action: Texas Children’s Health Plan (TCHP) would like to remind providers that Texas Health and Human Services Commission (HHSC) has selected HHAeXchange as the state EVV vendor. Take Action Now: Onboard with HHAeXchange To remain compliant with EVV requirements, program providers and FMSAs transitioning to HHAeXchange or who have recently enrolled to provide personal care services (PCS), must complete onboarding and system user training before Oct. 1. Submit the HHAeXchange Provider...

By OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialists, , , 0 CommentsRead more...
Provider Alert!
08Sep

Provider Alert! Updated Clinical Prior Authorizations Criteria Guides

Date: September 8, 2023 Attention: All Providers Effective Date: July 31, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that the Texas Health and Human Services (HHSC) updated multiple clinical prior authorization criteria guides effective July 31, 2023. How this impacts providers: HHSC updated the following clinical prior authorization criteria guides with the noted changes: Anxiolytics/Sedatives/Hypnotics (ASH) Ramelteon Corrected step 4 in the Ramelteon criteria logic and diagram. Diazepam Added GCNs for diazepam (45092, 14210) to the prior authorization table Cytokine...

By OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialists, 0 CommentsRead more...
Provider Alert!
01Sep

Provider Alert! Annual Chlamydia Screening Reminder

Date: September 1, 2023 Attention: OBGYNs and Primary Care Providers Annual chlamydia screening is recommended for all sexually active women ages 16 to 24, as well as older women with risk factors such as new or multiple sex partners, or a sex partner who has a sexually transmitted infection. Nucleic Acid Amplification Tests (NAATs) are the most sensitive tests, and can be performed on easily obtainable specimens, such as urine or vaginal swabs clinician- or patient-collected). Why it matters: Chlamydia is the most commonly...

By OB/GYNs, Primary Care Providers, Provider Alert, , 0 CommentsRead more...
Provider Alert!
01Sep

Provider Alert! EVV HHAeXchange Updates: Onboarding, System User Training & Alternative Device Policy

Date: September 1, 2023 Attention: STAR Kids Providers/Consumer Directed Services employers, and FMSA Providers Call to action: Texas Children’s Health Plan (TCHP) would like to remind providers that Texas Health and Human Services Commission (HHSC) has selected HHAeXchange as the state EVV vendor. Onboarding The HHAeXchange Provider Onboarding Form is used to create and configure the HHAeXchange Portal. The person who submits the form will be the provider’s point of contact and will receive all communication from HHAeXchange. Personal care services program providers and Financial...

By OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialists, , , , 0 CommentsRead more...