Provider Alert

Articles with information about Provider Alerts.

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...

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

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

By Facilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialists, , , 0 CommentsRead more...
Provider Alert!
20Jun

Provider Alert! HHSC to Add New Qulipta® Indication to Clinical Prior Authorization

Date: June 20, 2023 Attention: All Providers Effective Date: June 27, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective June 27, 2023, Texas Health and Human Services (HHSC) will follow the Food and Drug Administration’s recent approval of new indication for atogepant (Qulipta®), to prevent chronic migraine in adults. How this impacts providers: Starting June 27, 2023, TCHP will implement the new indication for atogepant (Qulipta®) to prevent chronic migraine in adults. The new criteria...

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Provider Alert!
20Jun

Provider Alert! Prior Authorization Diagnosis Coding Reminder

Date: June 20, 2023 Attention: All Providers Call to action: As a reminder, Texas Children’s Health Plan (TCHP) aligns with the Texas Medicaid Provider Procedure Manual (TMPPM) regarding the ICD-10-CM diagnosis-coding requirement on claim submissions. Resource: TMPPM Section 6: Claims filing How this impacts providers: Diagnosis codes guidance as outlined in the TMPPM are as follows: Diagnosis codes must be to the highest level of specificity available Diagnosis codes must be appropriate for the age of the client as identified in the ICD-10-CM description of the...

By HHSC, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialists, , 0 CommentsRead more...
Provider Alert!
14Jun

Provider Alert! Member Eligibility Verification Methods and Information on Medicaid Billing!

Date: June 14, 2023 Attention: All Providers Member eligibility information: Texas Children’s Health Plan (TCHP) would like to remind providers that the Medicaid and/or CHIP coverage rules changed, beginning April 1, 2023. This means that some of our members will need to go through the process to determine their eligibility for coverage. Our members will be required to renew their Medicaid and/or CHIP coverage or risk losing their plan and access to healthcare. TCHP has actively communicated with members about this change...

By Facilities, HHSC, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialists, , 0 CommentsRead more...
Provider Alert!
14Jun

Provider Alert! FMSA Cost Survey

Date: June 13, 2023 Attention: Financial Management Services Agencies (FMSA) Due date: August 31, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to make FMSAs aware of a cost survey with a due date of August 31, 2023. Background information: The purpose of the cost survey is to collect FMSA costs for the state fiscal year 2022 for all FMSAs in Texas. This cost information will be referenced in the review of current FMSA rates for Medicaid and Non-Medicaid programs. Health and Human Services...

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Provider Alert!
09Jun

Provider Alert! HHSC to Implement Pulmonary Hypertension Agents Clinical Prior Authorization on July 27, 2023

Date: June 9, 2023 Attention: All Providers Effective Date: July 27, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective July 27, 2023, Texas Health and Human Services (HHSC) will be implementing clinical prior authorization criteria for Pulmonary Hypertension Agents. How this impacts providers: Starting July 27, 2023, TCHP will implement the Pulmonary Hypertension Agents clinical prior authorization criteria. Updated prior authorization (PA) forms will be accessible on Navitus. It is crucial for all providers to...

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