Provider Alert – Page 62

Articles with information about Provider Alerts.

09DecDecember 9, 2020

Provider Alert! Updated Vision Benefit Codes

Attention: Optometrists and ophthalmologists Effective Date: March 9, 2021 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event. TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event. Call to action: Texas Children’s Health PLAN (TCHP) would like to inform network providers of the updated benefit codes for vision services. These services are categorized as either a routine or...

By tcphProvider Alert, Specialistsvision benefit codes0 CommentsRead more...

08DecDecember 8, 2020

Provider Alert! Annual Utilization Management Notice to All Providers

Attention: All Providers Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event. TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event. Affirmative Statement about Incentives As a reminder, Texas Children’s Health Plan (TCHP) Utilization Management (UM) decision-making is based on our Policies, Procedures, and Guidelines. They are based only on appropriateness of care and service and the existence...

By tcphOB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialists, UncategorizedUtilization Management0 CommentsRead more...

07DecDecember 7, 2020

Provider Alert! Synagis Administration as a Home Health Service

Attention: All Providers Effective Date: November 23, 2020 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event. TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event. Call to action: Texas Children’s Health Plan (TCHP) aligns with the Health and Human Services Commission (HHSC) to provide expanded access to Synagis. Synagis may now be provided with home health services...

By tcphOB/GYNs, Office Managers, Primary Care Providers, Provider Alert, SpecialistsHome Health Service, Synagis0 CommentsRead more...

07DecDecember 7, 2020

Provider Alert! Reminder of Therapy Benefits and Services Requiring a Prior Authorization

Attention: Primary Care, Therapy Providers, and Sub-specialties Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event. TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event. Call to action: Texas Children’s Health Plan (TCHP) would like to remind network providers of therapy benefits and those services that require a prior authorization. Benefit: Physical therapy and occupational therapy provided in the...

By tcphPrimary Care Providers, Provider Alert, SpecialistsPrior Authorization, therapy benefits0 CommentsRead more...

03DecDecember 3, 2020

Provider Alert! New Online Authorization Platform for Providers

Attention: All Providers Effective Date: January 1, 2021 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event. TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event. Call to action: Texas Children’s Health Plan (TCHP) would like to inform our network providers that currently have access to Clear Coverage, our online authorization tool, that beginning January 1, 2021; Clear...

By Texas Children's Health PlanOB/GYNs, Office Managers, Primary Care Providers, Provider Alert, SpecialistsAntipsychotic Clinical Prior Authorization Edit, Clear Coverage, health trio, provider alert, provider alerts0 CommentsRead more...

30NovNovember 30, 2020

Provider Alert! Utilization Management COVID-19 Procedure Update

Attention: Therapy, LTSS, Private Duty Nursing, and DME Service Providers Effective Dates: December 1, 2020 and March 1, 2021 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event. TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event. Call to action: Texas Children’s Health Plan (TCHP) would like to inform network providers of the following updates made to the...

By tcphProvider Alert, SpecialistsCOVID, COVID-190 CommentsRead more...

30NovNovember 30, 2020

Provider Alert! Benefit reminder and Prior Authorization Update for Spravato

Attention: Behavioral health Providers Effective Date: January 1, 2021 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event. TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event. Call to action: Texas Children’s Health Plan (TCHP) aligns with the Health and Human Services Commission (HHSC) on the revised prior authorization criteria for Spravato (Esketamine). Effective January 1, 2021, HHSC...

By tcphProvider Alert, SpecialistsPrior Authorization, Spravato0 CommentsRead more...

30NovNovember 30, 2020

Provider Alert! Medically Dependent Children Program Waiver (MDCP) Eligibility Process and Peer-to-Peer Review

Attention: Primary Care Providers and Sub Specialists Effective Date: December 1, 2020 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event. TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event. Call to action: Per Texas Health and Human Services Commission (HHSC) contract changes effective December 1, 2020, Texas Children’s Health Plan (TCHP) would like to inform network providers...

By tcphPrimary Care Providers, Provider Alert, SpecialistsMDCP, MDCP Waiver0 CommentsRead more...

24NovNovember 24, 2020

Provider Alert! Zolgensma Update – new TMPPM criteria pending publication

Attention: Neurologists and SMA specialists Effective Date: December 1, 2020 Call to action: Prescribers should be aware of an update to prior authorization criteria for Zolgensma (onasemnogene abeparvovec) drug HCPCS code J3399. Zolgensma is indicated for treatment of pediatric patients (<2 years of age) with Spinal Muscular Atrophy (SMA). Effective December 1, diagnosis of Type I SMA (diagnosis code G120) will require three or less copies of SMN-2. Previous criteria required two or fewer copies. All other criteria will remain the same. How this impacts providers:...

By tcphProvider Alert, SpecialistsTMPPM, Zolgensma0 CommentsRead more...

19NovNovember 19, 2020

Provider Alert! Updates to Prior Authorization Requirements for Genetic Testing, Wheelchair accessory, and Personal Care Services

Attention: All providers Effective Date: March 1, 2021 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event. TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event. Call to action: Texas Children’s Health Plan (TCHP) would like to inform network providers of services that require a prior authorization effective March 1, 2021. Genetic Testing Codes: 81202 APC (adenomatous polyposis coli) (eg,...

By tcphOB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialistsgenetic testing, Personal Care Services, Prior Authorization, Prior Authorization Requirements, wheelchair accessory0 CommentsRead more...