Provider Alert

Articles with information about Provider Alerts.

Provider Alert!
19Jul

Provider Alert! Prior Authorization Updates for Neurostimulators and Neuromuscular Stimulators

Date: July 18, 2023 Attention: All Providers Effective date: July 1, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers of a new prior authorization requirement effective July 1, 2023, for neurostimulators and transcutaneous electrical supply- CPT Code A4560. How this impacts providers: This prior authorization requirement aligns with the TMPPM and applies to all lines of business CHIP, STAR, and STAR Kids. There is a limit to one unit every 12 weeks or four units per year. Source: Texas...

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Provider Alert!
19Jul

Provider Alert! Zynteglo® now a Medicaid and CHIP Benefit – Prior Authorization Effective September 1, 2023

Date: July 18, 2023 Attention: All Providers Effective Date: September 1, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective September 1, 2023, the Texas Health and Human Services (HHSC) will be implementing required prior authorization criteria for Zynteglo® (procedure code J3590) for Medicaid and CHIP. Zynteglo® became a benefit of Medicaid and CHIP on July 1, 2023. Zynteglo® (betibeglogene autotemcel) is an autologous stem cell-based gene-therapy indicated for treating adult and pediatric patients with...

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13Jul

Provider Alert! Reimbursement for COVID-19 Vaccines for FQHCs and RHCs Reminder

Date: July 13, 2023 Attention: FQHC and RHC Providers End date for vaccine procedure codes: May 12, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to remind FQHC and RHC providers of the guidance from Texas Medicaid and Healthcare Partnership (TMHP) on COVID-19 vaccine procedure codes. Effective for dates of service on or after May 12, 2023, claims submitted by federally qualified health centers (FQHCs) and rural health clinics (RHCs) for the administration of COVID-19 vaccines will no longer be...

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Provider Alert!
13Jul

Provider Alert! No-cost sports and school physicals for CHIP and Medicaid patients

Date: July 13, 2023 Attention: Primary Care Providers, OB/GYNs, and Office Managers Call to action:  It will soon be back-to-school season, which means your patients will need to complete their annual sports and school physicals. As part of the Healthy Rewards Program*, Texas Children’s’ Health Plan CHIP, STAR and STAR Kids members ages 5 to 19 years** can receive a no-cost sports and school physical. A Texas Health Steps or well-child visit within the last 12 months is required. Members should bring...

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Provider Alert!
13Jul

Provider Alert! Signature Updates to Home Health Prior Authorization Request Forms

Date: July 12, 2023 Attention: All Providers Effective date: July 1, 2023 Call to action: The purpose of this communication is to provide awareness that the signature requirements for Title XIX (Medicaid) Home Health Services have changed. Medicaid-enrolled physicians and allowed practitioners can now sign prior authorizations and order covered Medicaid Home Health Services, including skilled nursing, home health aide services, durable medical equipment and supplies, and adult physical and occupational therapy services. An allowed practitioner is a physician assistant (PA) or an advanced...

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Provider Alert!
13Jul

Provider Alert! Clinical Criteria for Tzield® (procedure code J9381) effective August 1, 2023

Date: July 11, 2023 Attention: All Providers Effective Date: August 1, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective August 1, 2023, the Texas Health and Human Services (HHSC) will be implementing prior authorization criteria for Tzield ® (procedure code J9381). The approval duration will be for the 14-day treatment. Tzield is the first-in-class therapy indicated to delay the onset of Stage 3 Type 1 diabetes (T1D) in adults and pediatric patients 8 years...

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Provider Alert!
07Jul

Provider Alert! Noninvasive Prenatal Screening Benefits to Change for Texas Medicaid July 1, 2023

Date: July 7, 2023 Attention: All Providers Effective Date: July 1, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective July 1, 2023, noninvasive prenatal screening (NIPS) benefits will change for Texas Medicaid. How this impacts providers: Effective July 1, 2023, major changes to this medical benefit include the following: Updated benefit eligibility criteria Removed fee-for-service (FFS) prior authorization requirement NIPS is a benefit for members who have a confirmed intrauterine singleton pregnancy dated at least ten weeks gestation. Members...

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Provider Alert!
29Jun

Provider Alert! Case Management for Children and Pregnant Women (CPW) Carve-In Reminder

Date: June 29, 2023 Attention: All Providers Call to action: The purpose of this communication is to remind providers of the Case Management for Children & Pregnant Women (CPW) carve-in to Medicaid that became effective September 1, 2022. Background: House Bill 133, 87th Legislature, Regular Session, 2021, requires the case management for children and pregnant women benefit to be carved-in to Medicaid managed care, which means Medicaid managed care organizations like Texas Children’s Health Plan (TCHP) will contract with and reimburse providers...

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Provider Alert!
23Jun

Provider Alert Texas Health Steps Dental Services Reminder

Date: June 23, 2023 Attention: Primary Care Providers Call to action: Due to an increase in the number of TCHP members utilizing emergency services for dental-related visits, we would like to remind providers of the importance and availability of preventive dental care for children receiving Texas Health Steps services. Additionally, almost 23 percent of US children ages 2 through 5 have experienced dental caries in primary teeth, highlighting the need for early preventive services. Early childhood cavities are the most common chronic...

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Provider Alert!
22Jun

Provider Alert! New Fax Line for Post Hospital Discharge Authorizations

Date: June 22, 2023 Attention: All Providers Effective date: July 1, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers of a recent update to the prior authorization fax lines. On July 1, 2023, a new line will be added. This fax line will be used to send in authorization requests for members who are hospitalized at the time of request and services or equipment that are necessary for care of the member immediately after discharge. Requests unrelated to discharge...

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