Specialists

Articles with relevant information for Specialists.

Provider Alert! COVID-19 Guidance for FMSAs and CDS Employers

Attention: All Providers Effective Date: March 20, 2020 Providers should monitor the Texas Children’s Health Plan 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.   STAR, STAR Kids, STAR Health, STAR+PLUS: COVID-19 Guidance for the Consumer Directed Services (CDS) Option   Background: In response to COVID-19, HHSC is providing guidance to MCOs and Financial Management Services Agencies (FMSAs) regarding requirements in the [...]

Provider Alert! CHIP co-pays waived for office visits in response to COVID-19

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.   To help families in accessing care during the COVID-19 response, TCHP supports the Health and Human Services’ decision to waive office visit co-payments for all CHIP members for services provided March 13, 2020, through April 30, 2020.Providers [...]

Provider Alert!

Provider Alert! Reminder of mailing address and procedure for overpayments

Attention: All Providers Effective Date: March 20, 2020 Should a provider receive an overpayment from Texas Children’s Health Plan they should immediately take the following action. A provider has an obligation to notify Texas Children’s Health Plan in writing upon identification of an overpayment, no more than thirty (30) days from the date of discovery. The overpayment can be remediated through refund to Texas Children’s Health Plan, or a provider may request a recoupment from future claim payments.   For refunds: If a provider [...]

Provider Alert!

Provider Alert! New “Black Box” warning for Singulair (montelukast) and generic formulations

Attention: PCPs, Pulmonologists, and Pharmacists Effective Date: March 20, 2020 After careful analysis of the benefits and risks, the Food and Drug Administration (FDA) has strengthened the existing warnings on potential side effects on all Singulair and generic montelukast formulations. A “Black Box” warning has been included to stress the potential for serious side effects, including but not limited to serious behavior and mood-related changes. The FDA has also advised restricting the use for allergic rhinitis (hay fever) to those not [...]

Provider Alert! Anywhere Care (Telemedicine): How to become a participating provider

Attention: All Providers Effective Date: March 20, 2020 In order to reduce exposure to the Coronavirus Disease (COVID-19) and slow the spread of the illness, Texas Children’s Health Plan is promoting the use of Telemedicine, a covered benefit. We hope you are able to adapt your practice to delivering care via telemedicine. An increased use of telemedicine services will result in three immediate benefits: Preventing emergency rooms from being overcrowded. Limiting exposure among health care workers to infected individuals. Lessening the use of masks, gowns [...]

Provider Alert! COVID-19 Disaster Declaration – Texas Children’s Health Plan Operational Adjustments

Attention: All Providers Effective Date: March 13, 2020 TCHP affiliated providers should monitor the 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.   Reporting adjustments to normal provider business operations Texas Children’s Health Plan has developed a provider notification survey which is posted on the Provider portal www.texaschildrenshealthplan.org/for-providers and the website. This survey allows providers to self-report [...]

Provider Alert! COVID-19 Disaster Declaration – Prior Authorization Adjustments

Attention: All Providers Effective Date: March 18, 2020 TCHP affiliated providers should monitor the 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.   As a result of the COVID-19 Disaster Declaration, TCHP has instituted the following:   In order to increase access to primary care services, TCHP is now waiving prior authorization requirements for out-of-network primary care visits [...]

Provider Alert! Update – Telemedicine & Telehealth Services and COVID-19

Attention: All Providers Effective Date: March 17, 2020 Texas Children’s Health Plan supports the delivery of telemedicine and telehealth services to its members. As part of our COVID-19 Emergency Response, Texas Children’s Health Plan will add coverage of telemedicine services that are provided through only synchronous audio interactions (audio-only telephone consultation). How this impacts providers: Telemedicine services should be provided in compliance with standards established by the respective licensing or certifying board of the professional providing the services. While telemedicine services do not [...]

Provider Alert! Reporting Provider Office Closures and Changes due to COVID-19

Attention: All Providers Effective March 17, 2020 Reporting Provider Office Closures and Changes due to COVID-19 The severity of the Coronavirus disease 2019 (COVID-19) may have affected your ability to operate during normal business hours. If your office has made any changes to the regular business operations or has closed entirely and unable to provide services to our members at this time, please complete an online questionnaire on our main website, https://www.texaschildrenshealthplan.org/for-providers. Be sure to include any changes to your office status and [...]

Provider Alert!

Provider Alert! Prosthetics Codes Update

Effective Date: June 3, 2020 Attention: Prosthetics, DME providers, orthopedists, podiatrists, PCPs Call to action: Texas Children’s Health Plan will now configure the prosthetics procedures codes according to the Texas Medicaid Provider Procedures Manual (TMPPM).  For STAR and STAR Kids claims all codes with the exception of L8499 (unlisted procedure for miscellaneous prosthetic services) do require a prior authorization. Currently, the only procedure codes on the prior authorization list are related to Breast Reconstruction. How this impacts providers: Provider offices should utilize [...]