Specialists

Articles with relevant information for Specialists.

Provider Alert!

Provider Alert! 2021 Evaluation and Management (E/M) Guideline Changes

Attention:  All Providers Effective Date: January 1, 2021 Call to action: Evaluation and Management (E/M) Guidelines for new and established patient office visits and other outpatient services have gone through substantial revisions by the American Medical Association (AMA) and the Centers for Medicare & Medicaid Services (CMS). These changes are effective on January 1, 2021 and only affect the new and established patient office visits and outpatient codes (CPT 99201 – 99215). Code 99201 will be eliminated. The History and Physical Examination are no longer [...]

Provider Alert!

Provider Alert! Annual Electronic Visit Verification (EVV) Training Webinar

Attention: Current Electronic Visit Verification (EVV) Users Effective Date: 10/29/2020 Call to action: The webinar is for program providers currently required to use electronic visit verification by state law. Attending the webinar helps complete annual EVV policy and EVV Portal training requirements. There will also be a live question and answer session. The training is on November 13, 2020 at 8:30 a.m. – 12:30 p.m. How this impacts providers: Effective August 1, 2020, the Health and Human Services Commission (HHSC) Electronic Visit [...]

Provider Alert!

Provider Alert! Prior Authorization Guideline updates for TMJ and Skilled Nursing Facility

Attention: All Providers Effective Date: August 25, 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) would like to inform you of recent updates to the prior authorization requirements and the effective dates. The following codes for each service [...]

Provider Alert!

Provider Alert! TCHP Psychotropic Medication Utilization Review (PMUR)

Attention: Pediatricians, Psychiatrists Call to action: Texas Children’s Health Plan (TCHP) utilizes a PMUR program to promote safe prescribing of behavioral health medications to children and adolescents.  TCHP identifies potential “prescribing outliers” using parameters established by the Texas Health and Human Services (HHSC).  This does not mean the prescribing is wrong or harmful to the child, but requires additional review due to potential for adverse reactions, polyprescribing, and other implications. Who is identified for review? Members under the age of 18 years [...]

Provider Alert!

Provider Alert! Subject: Codes: K0108, A9900, and E1399 Wheelchair Guideline

Attention: All Providers Effective Date: October 22, 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. In follow-up to our Provider Alert posted on 7/13/2020 regarding wheelchair accessories, Texas Children’s Health Plan did not implement changes to the current process for prior authorization of codes:  K0108, A9900, and [...]

Provider Alert!

Provider Alert! Texas Children’s Health Plan Special Investigations Unit and Claims Payment Review Information

Attention: All Providers Effective Date: October 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) would like to share information with our provider network on two important topics, the Special Investigation Unit and Claims Payment Reviews. What is the [...]

Provider Alert!

Provider Alert! New prior authorization requirements for Teprotumumab-trbw (Tepezza)

Attention: Ophthalmologists and Endocrinologists Effective Date: January 19, 2021 Call to action: Texas Children’s Health Plan (TCHP) is aligning prior authorization criteria for teprotumumab-trbw (Tepezza), J3241 (formerly procedure code C9061), with the Texas Medicaid Provider Procedures Manual (TMPPM). Tepezza is a clinician administered drug indicated for members with thyroid eye disease (TED). Below are the new prior authorization criteria for TCHP members effective 1/19/2021. For initial therapy, ALL of the following criteria must be met: A diagnosis of Graves’ disease (diagnosis [...]

Provider Alert!

Provider Alert! Medicaid, STAR Kids, CHIP, and CHIP Perinatal eligibility during COVID-19

Attention: All Providers Effective Date: July 31, 2020 – January 21, 2021 The content in this message will remain in effect through the public health emergency period, extended to January 21, 2021, as announced by the U.S. Health and Human Services Department. TCHP COVID-19 Utilization Management Procedure and TCHP provider alerts can be found here: http://www.thecheckup.org/provider-alerts/ 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 [...]

Provider Alert!

Provider Alert! Online Learning Opportunity: Pediatric Brain Health Summit on November 5-6, 2020

Attention: Primary Care Providers, Neurologists, Early Childhood Specialists, and relevant 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. Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that the 2020 Pediatric Brain Health Summit is being held online November 5-6, 2020. [...]

Provider Alert! Texas Children’s Health Plan to host live CME Event

Paying Attention to ADHD: Diagnosis, Treatment & Resources  Texas Children’s Health Plan is hosting a new CME: Paying Attention to ADHD: Diagnosis, Treatment & Resources. This is a free CME for contracted family practice and pediatric providers that will offer two course credits   Thursday, October 29, 2020 – 5:30-7:30 p.m. – Live stream via WebEx   Topics covered will include: Diagnosis and treatment of ADHD Community supports & resources Pharmacy navigation with the state formulary What is CPAN [...]