Provider Alert

Articles with information about Provider Alerts.

Meet Our New President

Lou Fragoso has been appointed president of Texas Children’s Health plan. He joined Texas Children’s Pediatrics in February 2014 and was vice president of Business Operations. Prior to joining Texas Children’s, Lou was in leadership roles at Baylor College of Medicine in Houston and at Lurie Children’s Hospital in Chicago. Lou is a Certified Public Accountant with over 20 years of healthcare finance and management experience. Since joining Texas Children’s Pediatrics, Lou spearheaded the creation of Texas Children’s Urgent Care. [...]

Attention: Star Kids Providers: Prior Authorization required on all Vendor Drug Program (VDP) identified medications

Texas Children’s Health Plan requires prior authorization (PA) on all medications on the VDP website prior to dispensing to members. To obtain a list of medications requiring prior authorization, visit the VDP website at: http://www.txvendordrug.com/formulary/preferred-drugs.shtml Providers can also view instructions on accessing and using the formulary at the Texas Children’s Health Plan website: http://www.thecheckup.org/2016/06/09/do-you-know-how-to-access-the-texas-childrens-health-plan-formulary/ Providers can submit PA documentation to Texas Children’s Health Plan’s pharmacy benefit manager, Navitus. PA forms can be found here: https://www.navitus.com/texas-medicaid-star-chip/prior-authorization-forms.aspx Prior authorizations need to be submitted to Navitus by faxing [...]

Provider Alert!

Provider Alert! LTSS Provider Claims Request

Attention Long Term Services and Supports Providers Texas Children’s Health Plan would like to ensure that we have received all your claims from November 1st 2016, the program start date for STAR Kids. If you should have any questions related to claim submission and/or billing requirements, please contact Provider Relations at 1-800-731-8527. Your  Provider Relations team is prepared to guide you through the billing standards necessary to accurately bill Texas Children’s Health Plan and receive your payments timely. The Texas Children’s Health [...]

What is the role of STAR Kids Service Coordinators?

A Service Coordinator is the central contact between Texas Children’s Health Plan and a member’s providers and family members. The purpose of a Service Coordinator is to maximize a Member’s health, wellbeing and independence. The Service Coordinator must work with the Member’s PCP to coordinate all of a member’s health services. The STAR Kids Service Coordinator also engages as an advocate and intervenes on behalf of the member if approved by the member. The Service Coordinator will perform an overall [...]

Provider Alert!

Provider Alert! Prior Authorization required on all Vendor Drug Program (VDP) identified medications

Attention: Star Kids Providers Subject: Reminder: Prior Authorization required on all Vendor Drug Program (VDP) identified medications Texas Children’s Health Plan requires prior authorization (PA) on certain medications per the VDP website prior to dispensing to members. To obtain a list of medications requiring prior authorization, visit the VDP website at: http://www.txvendordrug.com/formulary/preferred-drugs.shtml Providers can also view instructions on accessing and using the formulary at the Texas Children’s Health Plan website: http://www.thecheckup.org/2016/06/09/do-you-know-how-to-access-the-texas-childrens-healthplan-formulary/ Providers can submit PA documentation to Texas Children’s Health Plan’s pharmacy benefit manager, [...]

Provider Alert!

Provider Alert! Prior Authorization for Sleep Studies

Effective February 1, 2017 Texas Children's Health Plan will require prior authorization on all sleep studies in children ages 18 and under. Claims for services on or after February 1, 2017 will be denied if no authorization is present. Please contact Texas Children's Health Plan Provider Relations at 1-800-731-8527, or visit the Texas Children's Health Plan Provider portal at http://www.tchp.us/for-providers for a copy of the guidelines utilized to determine medical necessity for sleep studies in children.

Provider Alert!

Provider Alert! Reminder on ability to bank respite hours for MDCP members

Attention: All STAR Kids Providers February 1st 2017 Subject: Reminder on ability to bank respite hours for MDCP members Texas Children’s Health Plan would like to remind all STAR Kids providers who are providing respite care to members of the standards around respite care hours and how Texas Children’s Health Plan manages these hours. The information below is directly from HHSC and is the guidance Texas Children’s Health Plan follows for determining respite care. Please always contact either Texas Children’ Health [...]

Texas Children’s Health Plan rolls out STAR Kids program in Tyler

Texas Children’s Health Plan recently opened its newest location in Tyler to serve the STAR Kids population in the northeast service area. A ribbon cutting ceremony at the office’s 100 East Ferguson in Tyler marked the grand opening of the satellite office. “We’re very excited to have the chance to serve families and their children with disabilities in Tyler and across Northeast Texas,” said Gail Bean, Provider and Care Coordination Regional Director. “We believe our long legacy and commitment to [...]

Provider Alert!

Provider Alert! Effective Provider Alternate Addresses

Attention: all Texas Children’s Health Plan Providers Subject: Provider Alternate Addresses Medicaid enrolled providers must have all service locations reflected in their state enrollment record prior to Medical Transportation Program (MTP) authorizing transportation for a client to the provider’s location. If an alternate address is not listed within the provider’s file sent to MTP, authorization will be denied. This means that every address where a provider will perform services has to have an active attested TPI. If all service locations are not [...]

Provider Alert! Health Advisory Issued on Mumps Outbreaks in Texas

The Texas Department of State Health Services issued a Health Advisory on 11/30/2016 due to two outbreaks of mumps in North Central Texas. An outbreak in Dallas County involves 5 adults and a Johnson City outbreak involves 10 cases, mostly in children. Several other outbreaks have occurred in the US outside of Texas. DSHS requests that physicians "please consider mumps as a diagnosis for any patients presenting with the following symptoms, particularly those who have traveled out of the state or [...]