Specialists

Articles with relevant information for Specialists.

Provider Alert!

Provider Alert! Providers who are leaving the TCHP Participating Provider Network

Attention: All Providers Effective Date: State Fiscal QTR 3 & 4 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 and its continued governmental Emergency Declaration. CHANGES TO THE TCHP PARTICIPATING PROVIDER NETWORK The following is a list of providers and practitioners that have left and/or will be [...]

Provider Alert!

Provider Alert! VDP Formulary Update for Behavioral Health

Attention: Behavioral Health Providers Effective Date: July 30, 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 Thursday, July 30, 2020, the Texas Vendor Drug Program (VDP) updated the Medicaid formulary.  Adderall XR is now a non-preferred drug, and generic amphetamine/dextroamphetamine ER formulations are [...]

Provider Alert!

Provider Alert! Prior authorization update for Reblozyl, procedure code J0896

Attention: Hematologists Effective Date: September 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: Texas Children’s Health Plan (TCHP) will align the prior authorization requirements for Reblozyl with Texas Medicaid Healthcare Partnership (TMHP) guidance. A prior authorization will be required beginning September 1, [...]

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

Attention: All providers Effective Date: July 31, 2020 – October 23, 2020 The content in this message will remain in effect through October 23, 2020 as announced by the Health and Human Services Commission (HHSC). TCHP COVID-19 Utilization Management Procedure and 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 update and/or change this information without prior notice due [...]

Provider Alert!

Provider Alert! Regulatory Guidelines & Appointment Availability Standards Reminder

Attention: Primary Care and Specialist 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 remind network providers of the appointment availability standards and regulatory requirements.  In 2015, Senate Bill 760 passed, requiring Texas Health and Human Services [...]

Provider Alert! HHSC Electronic Visit Verification Temporary EVV Policies for Novel Coronavirus (COVID-19)

Attention: LTSS Providers Effective Date: July 31, 2020 The content in this message will remain in effect through October 23, 2020 as announced by the Health and Human Services Commission (HHSC). TCHP COVID-19 Utilization Management Procedure and provider alerts can be found here: http://www.thecheckup.org/provider-alerts/ TCHP network 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 [...]

Provider Alert! Provider enrollment re-validation due dates extended in response to COVID-19

Attention: All Providers Effective Date: July 31, 2020 The content in this message will remain in effect through October 23, 2020 as announced by the Health and Human Services Commission (HHSC). TCHP COVID-19 Utilization Management Procedure and 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 update and/or change this information without prior notice due to the evolving nature [...]

Provider Alert! COVID-19 UPDATE ALERT #4 – Telemedicine Services – Physicians, BH, FQHC and RHC Providers

Attention: All Providers Effective Date: July 31, 2020   The content in this message on Rural Health Clinics as telehealth and telemedicine sites, telephone (audio-only) behavioral health services, and telephone (audio-only) medical services will remain in effect through October 23, 2020 as announced by the Health and Human Services Commission (HHSC). TCHP COVID-19 Utilization Management Procedure and 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 [...]

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

Attention: FMSA Providers Effective Date: July 31, 2020 The content in this message will remain in effect through October 23, 2020 as announced by the Health and Human Services Commission (HHSC). TCHP COVID-19 Utilization Management Procedure and 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 update and/or change this information without prior notice due to the evolving nature of the [...]

Provider Alert: Guidance on Appeals and Fair Hearing Requests due to COVID-19

Attention: All Providers Effective Date: July 31, 2020 The content in this message on MCO Appeal Determinations expired on July 31, 2020. The remaining content will remain in effect through October 23, 2020 as announced by the Health and Human Services Commission (HHSC). TCHP COVID-19 Utilization Management Procedure and provider alerts can be found here: http://www.thecheckup.org/provider-alerts/ 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 [...]