Provider Alert – Page 7

Articles with information about Provider Alerts.

08DecDecember 8, 2023

Provider Alert! Change in Preferred Drug List Status for Glucocorticoids, Inhaled Drug Class

Date: December 8, 2023 Attention: Providers Effective date: December 15, 2023 Call to action: Effective December 15, 2023, the Texas Health and Human Services (HHS) removed non-preferred status from generic fluticasone hydrofluoroalkane (HFA) and brand Qvar products on the preferred drug list. This is in response to the discontinuation of the product by the manufacturer. The preferred status of the brand name Flovent HFA and Flovent Diskus will not change to allow for any remaining stock to be used. How this impacts providers: The change...

By Texas Children's Health PlanOB/GYNs, Office Managers, Primary Care Providers, Provider Alert, SpecialistsGlucocorticoids, PDL0 CommentsRead more...

08DecDecember 8, 2023

Provider Alert! Important Dates: Complete EVV Visit Maintenance and Submit VMURs Before Losing Access

Date: December 8, 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 program providers, financial management services agencies (FMSAs) and Consumer Directed Services (CDS) employers who are transitioning to HHAeXchange, are responsible for completing all required visit maintenance, including Visit Maintenance Unlock Requests (VMURs), in their current EVV vendor system, DataLogic/Vesta or First Data/AuthentiCare by Dec. 22, 2023. Any visits for dates of service on or after the program providers,...

By Texas Children's Health PlanOffice Managers, Primary Care Providers, Provider Alert, SpecialistsEVV, Visit Maintenance, VMURs0 CommentsRead more...

07DecDecember 7, 2023

Provider Alert! Follow-Up Care for Children Prescribed ADHD Medication (ADD, ADD-E)

Date: December 7, 2023 Attention: All Providers Call to Action: Texas Children Health Plan (TCHP) would like to remind providers to continue to take measures to ensure that your patients with an Attention Deficit Hyperactivity Disorder (ADHD) diagnosis are receiving excellent care. ADHD is one of the most common behavioral health disorders in children (National Committee for Quality Assurance, 2023; Visser et al., 2014). To ensure that medication is prescribed and managed correctly, it is important that prescribing providers carefully monitor their pediatric...

By Texas Children's Health PlanOB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialistsadd, ADD-E, ADHD0 CommentsRead more...

07DecDecember 7, 2023

Provider Alert! Coverage of Vyjuvek (procedure code J3401) Begins January 2024; Prior Authorization Effective February 2024

Date: December 6, 2023 Attention: All Providers Prior Authorization Effective Date: February 1, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that on January 1, 2024, Vyjuvek will become a benefit of Medicaid and CHIP. Texas Health and Human Services Commission (HHSC) will require prior authorization for Vyjuvek (procedure code J3401) for Medicaid and CHIP, effective February 1, 2024. Vyjuvek is the first U.S. Food and Drug Administration (FDA) approved topical gene therapy that delivers new COL7A1 genes...

By Texas Children's Health PlanOB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialistsdystrophic epidermolysis bullosa, gene therapy, Prior Authorization, skin wounds, Vyjuvek0 CommentsRead more...

07DecDecember 7, 2023

Provider Alert! Coverage of Roctavian (procedure code J1412) Begins January 2024; Prior Authorization Effective February 2024

Date: December 6, 2023 Attention: All Providers Prior Authorization Effective Date: February 1, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that on January 1, 2024, Roctavian will become a benefit of Medicaid and CHIP. Texas Health and Human Services Commission (HHSC) will require prior authorization for Roctavian (procedure code J1412) for Medicaid and CHIP, effective February 1, 2024. Roctavian (valoctocogene roxaparvovec-rvox) is an adeno-associated virus vector-based gene therapy indicated to treat adult clients with severe hemophilia A...

By Texas Children's Health PlanOB/GYNs, Office Managers, Primary Care Providers, Provider Alert, SpecialistsHemophilia, Prior Authorization, Roctavian0 CommentsRead more...

07DecDecember 7, 2023

Provider Alert! Coverage of Adstiladrin (procedure code J9029) Begins January 2024; Prior Authorization Effective February 2024

Date: December 6, 2023 Attention: All Providers Prior Authorization Effective Date: February 1, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective February 1, 2024, Texas Health and Human Services (HHSC) will be implementing prior authorization criteria for Adstiladrin (procedure code J9029). Adstiladrin (nadofaragene firadenovec-vncg) is an adenoviral vector-based gene therapy indicated to treat adult clients with high-risk Bacillus Calmette-Guérin (BCG)-unresponsive non-muscle invasive bladder cancer (NMIBC) with carcinoma in situ (CIS) with or without papillary...

By Texas Children's Health PlanOB/GYNs, Office Managers, Primary Care Providers, Provider Alert, SpecialistsAdstiladrin, BCG, CIS, gene therapy, NMIBC, Prior Authorization0 CommentsRead more...

07DecDecember 7, 2023

Provider Alert! Fee-for-Services (FFS) Telephone (Audio-Only) Telemedicine Services for Non-Behavioral Health Conditions

Date: December 7, 2023 Attention: All Providers Effective for dates of service on or after November 1, 2023 Call to action: The purpose of this communication is to offer information about the implementation of a new telemedicine services delivery method for certain non-behavioral health conditions. How this impacts providers: The following office and other outpatient telemedicine services may be provided by synchronous telephone (audio-only) technology for the diagnosis, evaluation, and treatment of non-behavioral health conditions if clinically appropriate and safe, as determined by the...

By Texas Children's Health PlanOB/GYNs, Office Managers, Primary Care Providers, Provider Alert, SpecialistsNon-Behavioral Conditions, telemedicine0 CommentsRead more...

05DecDecember 5, 2023

Provider Alert! Coverage of Commercialized COVID-19 Vaccines Begins as a Pharmacy Benefit

Effective Dates: As of September 11, 2023 & October 3, 2023 Date: December 4, 2023 Attention: All Providers Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective for dates of service on or after September 11, 2023 and October 3, 2023, the U.S. Food and Drug Administration’s (FDA) issued approval and Emergency Use Authorization (EUA) for the following COVID-19 vaccines: As of September 11, 2023: 2023-2024 Pfizer-BioNTech COVID-19 Vaccine 2023-2024 Moderna COVID-19 Vaccine As of October 3, 2023: 2023-2024 Novavax COVID-19 Vaccine The...

By Texas Children's Health PlanOB/GYNs, Office Managers, Primary Care Providers, Provider Alert, SpecialistsCOVID, COVID-19, Pharmacy, vaccine0 CommentsRead more...

05DecDecember 5, 2023

Provider Alert! Synagis (palivizumab) Clinical Prior Authorization Forms Updated with Revised Abrysvo Criteria

Date: December 4, 2023 Attention: All Providers Effective date: November 17, 2023 Call to action: On November 17, 2023, Health and Human Services Commission (HHSC) updated the Synagis Standard Prior Authorization Request (HHS Form 1321) to include a step to check for Abrysvo vaccine administration to the client’s mother during 32 to 36 weeks of pregnancy. How this impacts providers: Additional information on Abrysvo Vaccine include the following: Abrysvo is indicated for active immunization of pregnant individuals at 32 through 36 weeks gestational age for...

By Texas Children's Health PlanOB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialists, UncategorizedAbrysvo, clinical prior authorization, Synagis, vaccine0 CommentsRead more...

04DecDecember 4, 2023

Provider Alert! Meet Your New Quality Consultants to Support our Provider Network

Date: December 4, 2023Attention: All Providers Event dates are as follows:Session 1: December 19, 2023Session 2: December 21, 2023Session 3: January 8, 2024 All sessions will be will be from 12:00PM (Noon) – 1:00PM CST Introduction: The Provider Relations department would like to invite you to attend one of the upcoming sessions and introduce you to the new Quality Team that will support you and your practice to ensure optimal provider experience and performance for 2024. Sessions will be held online as a...

By Texas Children's Health PlanOB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialistsprovider network, Quality Consultants, quality team0 CommentsRead more...