Specialists

Articles with relevant information for Specialists.

Reminder: Tdap Vaccine Coverage for CHIP Perinatal Members

This reminder is to ensure that all providers are knowledgeable on which vaccines are covered for CHIP Perinatal (CHIP-P) members. Based on guidance from the Centers for Disease Control and Prevention (CDC), American Academy of Pediatrics (AAP), and American College of Obstetricians and Gynecologists (ACOG), the Tetanus, Diphtheria, and Acellular Pertussis (Tdap) vaccine is routine prenatal care and is covered in CHIP-P. As noted in the ACOG committee opinion: “The overwhelming majority of morbidity and mortality attributable to pertussis infection occurs [...]

Provider Alert! TCHP Prior Authorization Requirement

Effective January 1, 2019, TCHP will be updating the prior authorization listing. Please note there are some key changes for providers. Removed from the list and will no longer require prior authorization: Baclofen Pump New to the list: Home Telemonitoring Updates: Ambulance (non-emergent transport) has been updated to Non-Emergency Ambulance Transport. Augmentative Communication Device has been updated to Augmentative Communication Device and Accessories. Chemotherapy non-FDA approved has been updated to Non-FDA approved medications. Cranial Molding Orthosis (Helmets) has been updated to Cranial Molding Orthosis. High cost (>$50,000) injectable in the [...]

Nutritional supplement guideline change

Effective 10/1/2018, Texas Children’s Health Plan will no longer require prior authorization for nutritional products for members 20 years and younger who: receive all or part of their nutritional intake through a tube as documented by ICD-10 codes (z43.1; z93.1, z93.4), OR have a metabolic disorder that has been documented with one of the diagnosis codes listed in the current TMPPM Section 2.2.17.2.2. Providers will retain the responsibility of maintaining appropriate documentation for the nutritional products supplied. A retrospective review may be [...]

Texas Children’s Health plan provider and member portals

As a Texas Children’s Health Plan provider, you have access to the Texas Children’s Health Plan provider portal, called TouCHPoint. This portal can be used to check member eligibility, benefits, primary care provider selection, and claims status. To access Provider TouCHPoint, just log on to TexasChildrensHealthPlan.org/for-providers and find the TouCHPoint log-in on the right-hand side of the web page. Texas Children’s Health Plan members can access their own portal at TexasChildrensHealthPlan.org/for-members. The Member Portal allows your patients to play an [...]

Dental caries and fluoride varnish: not just for dentists

Dental caries remains the most common chronic disease of childhood in the United States.  In fact, dental caries affects more than half of Texas children. Primary care providers play a key role in the prevention of dental caries. To help ensure dental health, all children 6 months of age and older should be referred to a dental home. Additionally, periodic oral evaluations and application of fluoride varnish in the medical home during well child or THSteps exams can help [...]

Authorization and Verification Process Updates

Authorization and Verification Process Updates                                   Texas Children’s Health Plan has made updates to the authorization process. Individual Member Fax Requests To ensure Health Insurance Portability and Accountability Act (HIPAA) compliance, providers must send one fax request per member with each fax having its own cover sheet. Requests received with multiple members per fax will be returned to the provider and not processed. Minimum Information Required to Process a Request Providers must use the Texas Standard Prior Authorization Request Form*, which can be found [...]

Provider Alert! STAR Kids Billing Requirements

Attention: STAR Kids Providers REMINDER: STAR Kids Billing Requirements   As previously communicated, Texas Children’s Health Plan (TCHP) requires all STAR Kids providers billing for private duty nursing (PDN) services with the T1000 CPT code to use the billing matrix available on the Texas Health and Human Services website at https://hhs.texas.gov/laws-regulations/handbooks/star-kids-handbook/appendices/appendix-iii-ltss-billing-matrix-crosswalk. This requirement was effective June 5, 2017.   Failure to use this billing matrix, including placement of modifiers, will result in denials for incorrectly billed services.  Providers may receive line denials if [...]

Updating Texas Children’s Health Plan Member Change of Address Information

All address changes must be reported to HHSC. Members can contact HHSC by calling 2-1-1 or by updating their account on YourTexasBenefits.com. It is important to make sure address information is updated in a timely manner to ensure families continue to receive information from Texas Children’s Health Plan and HHSC. If a member has moved to an area that is not covered by Texas Children’s Health Plan, they will need to select a new health plan. If a family [...]

Texas Children’s Health Plan Provider and Member Portals

As a Texas Children’s Health Plan provider, you have access to the Texas Children’s Health Plan provider portal, called TouCHPoint. This portal can be used to check member eligibility, benefits, primary care provider selection, and claims status. To access Provider TouCHPoint, just log on to TexasChildrensHealthPlan.org/for-providers and find the TouCHPoint log-in on the right-hand side of the web page. Texas Children’s Health Plan members can access their own portal at TexasChildrensHealthPlan.org/for-members. The Member Portal allows your patients to play an [...]

October 11 is National Depression Screening Day

National Depression Screening Day is held annually in October. Depression is the leading cause of disability in the U.S. for ages 15-44. It is estimated that up to 64% of youth with major depressive disorder do not receive mental health treatment. Depression in youth has been linked to school and behavioral problems, self-injury and suicide, and poor social functioning. The incidence of perinatal depression ranges from 5 to 25 percent of pregnant and postpartum women, and studies of low-income [...]