Specialists

Articles with relevant information for Specialists.

Provider Alert!

Provider Alert! UPDATED Medicaid Re-enrollment Application Assistance is Available

Date: February 22, 2024 Attention: All Providers Call to action: Texas Children's Health Plan (TCHP) would like to remind providers that continued assistance is available to their patients who need help with their Medicaid Reenrollment Application. Providers should encourage patients with Texas Children’s Health Plan coverage to contact us for assistance and support. How can you help ensure your patients stay covered?  Your continued assistance is crucial to helping your patients maintain coverage so they can access health care. Please ask your patients to:  Make...

Provider Alert!

Provider Alert! Important: Change Healthcare Network Interruption

Date: February 22, 2024Attention: All Providers Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers of some recent information we have received from our clearinghouse, Change Healthcare.   Change Healthcare is experiencing a network interruption related to a cyber-security issue and are working to address the matter. Once they became aware of the infiltration, they took immediate action to disconnect their systems to prevent further impact. At this time, they do not have an estimation of when the system...

Provider Alert!

Provider Alert! EVV Program Providers and FMSAs: Register for HHAeXchange Webinar Friday, February 23

Date: February 20, 2024 Attention: STAR Kids Providers/Consumer Directed Services employers and FMSA Providers Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that program providers, financial management services agencies (FMSAs) and Consumer Direct Services (CDS) EVV Program Providers and FMSAs: Register for HHAeXchange Webinar Friday, February 23, 2024. HHAeXchange is hosting a Provider Forum: Navigating HHAeXchange webinar on February 23, for EVV program providers and financial management services agencies (FMSAs) who use HHAeXchange as their EVV system. The webinar...

Provider Alert!

Provider Alert! Update to Clarify Delivery of Certain Behavioral Health Services through Synchronous Audiovisual or Synchronous Telephone (Audio-Only) Technology

Date: February 16, 2024 Attention: Behavioral Health Providers Effective date: December 1, 2023 Call to action: The purpose of this communication is to provide further information about the October 26 Provider Alert.  This alert provides updates to some of the behavioral health Medicaid benefits and to clarify the delivery of those services through synchronous audiovisual or synchronous telephone (audio-only) technology that are effective December 1, 2023. Texas Children’s Health Plan (TCHP) follows the limitations and requirements for the corresponding behavioral health codes outlined by...

Provider Alert!

Provider Alert! Generic for Rapumune Tablets and Solutions (Sirolimus) Now Preferred

Date: February 16, 2024 Attention: All Providers Effective: February 12, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective February 12, 2024, sirolimus tablets and generics will now be preferred. This is in response to the discontinuation of the brand product Rapamune by the manufacturer. How this impacts providers: The change will allow providers to prescribe the generic without requiring Preferred Drug List (PDL) prior authorization at this time and continue accessing necessary medication for their...

Provider Alert!

Provider Alert! Reminder: Prior Authorization Form Completion

Date: February 13, 2024 Attention: All Providers Call to action: Texas Children’s Health Plan (TCHP) supports the guidance from Texas Health and Human Services Commission (HHSC) on rejecting the Prior Authorization (PA) received with incomplete or insufficient documentation per Uniform Managed Care Manual (UMCM), Chapter 3.22. ‘Essential Information’ is the information required to initiate the PA review process, and are as follows: Member name Member number or Medicaid number Member date of birth Requesting provider name Requesting provider’s National Provider Identifier (NPI) Service requested – Current Procedural Terminology (CPT),...

Provider Alert!

Provider Alert! Educational Video and Infographics Now Available to Providers: Telemedicine and Telehealth Delivery of Behavioral Health Medicaid Benefits

Date: February 13, 2024 Attention: Primary Care Providers (PCP), Family Medicine, and OBs acting as a PCP Video available beginning: February 2, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to make providers aware that Health and Human Services (HHSC) has created an educational video that is posted on the Texas Medicaid & Healthcare Partnership’s (TMHP’s) YouTube channel and Learning Management System (LMS). Additionally, HHSC created two infographics outlining the changes that are also posted to Texas Medicaid and Healthcare Partnership (TMHP’s) LMS. This training is...

Provider Alert!

Provider Alert! 12-Month Postpartum Eligibility Extension for Medicaid and CHIP Pregnant Members

Date: February 13, 2024 Attention: Primary Care, Family Medicine, and Obstetric Care Providers Effective: March 1, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to share great news with providers about postpartum Medicaid coverage. The Texas Health and Human Services Commission (HHSC) extended postpartum Medicaid coverage from two to 12 months for eligible women, effective March 1, 2024, as part of House Bill 12 (H.B. 12), 88th Legislature, Regular Session, 2023. Also effective March 1, 2024, HHSC will be providing 12...

Provider Alert!

Provider Alert! EVV Visit Maintenance Processes on Hold for Dates of Service Prior to Go-Live Date with Current EVV

Date: February 12, 2024 Attention: STAR Kids Providers/Consumer Directed Services employers and FMSA Providers Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that program providers, financial management services agencies (FMSAs) and Consumer Direct Services (CDS) employers should not submit Visit Maintenance Unlock Requests (VMURs) for dates of service prior to going live with HHAeXchange or their EVV proprietary system. HHSC is actively working with Texas Medicaid & Healthcare Partnership (TMHP) to develop a solution to allow...

Provider Alert!

Provider Alert! Updated Prior Authorization Information for Benlysta (procedure code J0490) and Saphnelo (procedure code J0491)

Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers of prior authorization updates for Belimumab (Benlysta), procedure code J0490, and Anifrolumab-fnia (Saphnelo), procedure code J0491. Effective March 1, 2022, there is no prior authorization requirement for both, and age and diagnosis restrictions are indicated below. Benlysta (J0490) is indicated to treat the following:  Active, autoantibody-positive, systemic lupus erythematosus (SLE) in clients who are 5 years of age or older, and receiving standard therapy Adult clients with active Lupus Nephritis...