Provider Alert – Page 85

Articles with information about Provider Alerts.

19MayMay 19, 2017

Provider Alert! Enrollment Information for CHIP Providers

Attention CHIP Providers Enrollment Information Specific to CHIP Providers Federal law and regulation require states to screen and enroll all network providers including Children’s Health Insurance Program (CHIP) providers by December 31, 2017. To meet this requirement and continue receiving reimbursement for services, providers who currently render services to CHIP members through (Texas Children’s Health Plan) must complete enrollment with the Texas Medicaid & Healthcare Partnership (TMHP) by December 31, 2017. While the enrollment process and application are the same for Medicaid and...

By Texas Children's Health PlanProvider AlertCHIP, enrollment, PIMS, provider alert, tmhp0 CommentsRead more...

18MayMay 18, 2017

Provider Alert! STAR Kids Billing Matrix

Attention STAR Kids Providers Effective 06/05/2017 Updated STAR Kids Billing Matrix The STAR Kids billing matrix has been updated to include the registered nurse modifier (TD) to the private duty nursing (PDN) billing code, T1000. Additionally, the billing codes for PDN independently enrolled LVNs and RNs have been added to the matrix. The Revenue Code 663 was added to the Out-of-Home Respite codes. This billing matrix will become effective for dates of service June 5, 2017 and forward. Failure to use this...

By Texas Children's Health PlanProvider Alertbilling, provider alert, STAR Kids0 CommentsRead more...

17MayMay 17, 2017

TCHP now accepts Outpatient Authorizations for many services online via Clear Coverage effective June 1, 2017!

Tired of faxing authorization requests and medical records? Spending too much time on hold waiting to speak to an Authorization Specialist for non-urgent authorization request? Looking for a faster, more efficient way to submit authorizations? Why not submit your authorizations request through Clear Coverage? What are the benefits? Easy to access 24/7 online access to Clear Coverage Receive real time authorization status by viewing your office’s home page in Clear Coverage Services are immediately uploaded into Texas Children’s Health Plan’s authorization for clinical review Automatic APPROVALS may be...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, SpecialistsAuthorization, Authorizations, Clear Coverage, Outpatient0 CommentsRead more...

17MayMay 17, 2017

Provider Alert! Authorization Extension for STAR Kids Members

Attention STAR Kids Providers May 17, 2017 Authorization Extension for STAR Kids Members The Health and Human Services Commission expects managed care organizations to extend long term services and supports (such as Personal Care Services, Community First Choice, and Private Duty Nursing) authorizations for services until completion of the STAR Kids Screening and Assessment Instrument (SAI), but no longer than July 1, 2017. In order to receive payment for these services, you must have authorization from Texas Children’s Health Plan, and the SAI must be completed by...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, SpecialistsAuthorizations, provider alert, SAI, Screening and Assessment Instrument0 CommentsRead more...

01MayMay 1, 2017

Provider Alert! Screening for Maternal Depression – Essential to Child Well-Being

Effective January 1, 2017, Texas Children’s Health Plan will reimburse providers for maternal depression screening conducted at a well-child visit. Postpartum depression screening utilizing the Edinburgh Postnatal Depression Scale may be reimbursed up to 2 times per member ages 0-6 months, using CPT code 96161. Code 96161 is used to report the use of a standardized instrument to screen for health risks in the caregiver for the benefit of the patient. The reimbursement for this code will be based on...

By Texas Children's Health PlanOB/GYNs, Provider Alert, SpecialistsDepression, Fax Blast, maternal, OB, OBGYN, Obstetrics, Postpartum, provider alert, screening0 CommentsRead more...

15AprApril 15, 2017

Provider Alert! STAR Kids Prescription/Pharmacy Prior Authorizations Reinstated 4/15/17

PRESCRIPTION PRIOR AUTHORIZATION NOTIFICATION Subject: STAR Kids Prescription/Pharmacy Prior Authorizations Reinstated 4/15/17 Effective 4/15/17, Texas Children’s Health Plan (TCHP) will enforce pharmacy prior authorization (PA) requirements for STAR Kids members STAR Kids members who received a prescription between 11/1/16-4/15/17 were not subject to normal PA requirements. PA requirements were temporarily lifted during this period to help facilitate the transition to STAR Kids. After 4/15/17, all prescriptions for STAR Kids members will be subject to normal PA documentation, including non-preferred drugs and drugs that require...

By Texas Children's Health PlanProvider AlertPharmacy, Prior Authorization, provider alert, STAR Kids0 CommentsRead more...

07AprApril 7, 2017

Inpatient Authorization Requests through Clear Coverage

Texas Children’s Health Plan is excited to announce the upcoming implementation of Clear Coverage for inpatient authorization requests beginning May 1, 2017. Clear Coverage is a web-based system that provides an automated method for providers and health plans to manage authorizations for inpatient services at the point of decision. Clear Coverage enables automated authorization, notification, eligibility and direction of members to in-network service providers. Clear Coverage provides the following benefits: Providers have immediate access to coverage, medical appropriateness and network rules,...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, SpecialistsAuthorizations, Clear Coverage, Eligibility, McKesson, Notification0 CommentsRead more...

23MarMarch 23, 2017

Provider Alert! Prior Authorization Changes Coming

Attention: All TCHP Providers Subject: TCHP Prior Authorizations TCHP will be updating the services requiring a prior authorization effective April 1, 2017. Please note there are some key changes to make providers aware of. Physical Therapy, Occupational Therapy and Speech Therapy re-evaluations will no longer need to be prior authorized. The CPT codes for these services are: 97164, 97168, S9152 Spinraza(Nusinersen) has been added as a Medical Benefit by TMHP. Spinraza(Nusinersen) will require a prior authorization. TCHP will follow TMHP coding guidance located at http://www.tmhp.com/News_Items/2017/03-Mar/03-03-%2017%20Billing%20Process%20Reminder%20for%20Spinraza%20nusinersen.pdf A new TCHP prior...

By Texas Children's Health PlanOffice Managers, Provider Alertprovider alert0 CommentsRead more...

21MarMarch 21, 2017

Provider Alert! Epaned (enalapril oral solution)

Attention: Texas Children Health Plan Providers Subject: Epaned The manufacturer of enalapril oral solution (Epaned) changed the formulation from a powder for reconstitution to a prepared oral solution. The powder for reconstitution has been discontinued and the oral solution is not yet on the Texas VDP formulary. VDP is currently reviewing the new formulation to be added to the Texas VDP formulary. Until this issue is resolved, options for providers are: Find a pharmacy with the old Epaned (enalapril oral solution) product in...

By Texas Children's Health PlanProvider Alertenalapril, Oral Solution, provider alert, VDP Formulary0 CommentsRead more...

15MarMarch 15, 2017

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. Texas...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialistsleadership, president, texas children's health plan0 CommentsRead more...