Specialists

Articles with relevant information for Specialists.

Provider Alert!

Provider Alert! Prior authorization Updates   

Date: July 23, 2021 Attention: All Providers Effective Dates: August 1, 2021 and November 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: Services no longer requiring a prior authorization effective August 1, 2021 include the following: Biofeedback Codes 90901, 90912, and 90913 Durable Medical Equipment [...]

Provider Alert!

Provider Alert! 2021-2022 Respiratory Syncytial Virus Season Now Open in all Regions

Date: July 23, 2021 Attention: All Providers Treatment start date: June 21, 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. **This notice may be updated as new regions are opened or closed Call to action: Respiratory Syncytial Virus (RSV) activity has been highly unusual during the 2020-21 season. [...]

Provider Alert!

Provider Alert! Continuous Glucose Monitors Regular Durable Medical Supplies Limits

Date: June 18, 2021 Attention: Endocrinologists, PCPs and DME Providers Effective Date: August 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 providers of new limits for diabetic supplies processed through the medical benefit for [...]

Provider Alert!

Provider Alert! Trikafta Age Expansion in Cystic Fibrosis Agents Clinical Prior Authorization Begins September 1

Date: July 8, 2021 Attention: Primary Care Providers and Pulmonologists Effective Date: September 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 will update the clinical prior authorization criteria for Trikafta (elexacaftor, tezacaftor, ivacaftor) to align with the FDA recent [...]

Provider Alert!

Provider Alert! Reimbursement and Audit Notification on Surgical Procedure Codes (last updated July 1, 2021)

Date: July 1, 2021 Attention: All Providers Subject: 2021-2022 Reimbursement and Audit Notification on Surgical Procedure Codes (last updated July 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 provide information to providers that TCHP follows [...]

Provider Alert!

Provider Alert! Voluntary Recall Notice: Phillips Respironics Medical Devices

Date: June 29, 2021 Subject: Voluntary Recall Notice: Phillips Respironics Medical Devices 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 make providers aware of an important voluntary recall Philips Respironics has initiated for two of their [...]

Provider Alert!

Provider Alert! Nucala Clinical Prior Authorization Update

Date: June 29, 2021 Attention: Primary Care Providers and Pulmonologists Subject: Nucala Clinical Prior Authorization Update Effective Date: July 12, 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: The Health and Human Services Commission (HHSC) will update the clinical prior authorization criteria for Nucala in [...]

Provider Alert!

Provider Alert! MDCP Adaptive Aids Available through the Consumer Directed Services (CDS) Option

Date: June 25, 2021 Attention: FMSA Providers 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: Effective December 1, 2020, MDCP adaptive aids will be available through the CDS option. How this impacts providers: Adaptive aids are devices necessary to treat, rehabilitate, [...]

Provider Alert!

Provider Alert! MDCP Minor Home Modification Services Available through the CDS option

Date: June 23, 2021 Attention: FMSA Providers 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: Effective December 1, 2020, Medically Dependent Children Program (MDCP), minor home modifications services are available through the Consumer Directed Services (CDS) option. How this impacts providers: [...]

Provider Alert!

Provider Alert! Speech, Physical, and Occupational Therapy Prior Authorization Update

Date: June 23, 2021 Attention: Therapy and Primary Care Providers Effective Date: June 23, 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 providers of updated TCHP prior authorization requirements. How this impacts providers: Effective June 23, 2021, [...]