Specialists – Page 15

Articles with relevant information for Specialists.

14JunJune 14, 2023

Provider Alert! Member Eligibility Verification Methods and Information on Medicaid Billing!

Date: June 14, 2023 Attention: All Providers Member eligibility information: Texas Children’s Health Plan (TCHP) would like to remind providers that the Medicaid and/or CHIP coverage rules changed, beginning April 1, 2023. This means that some of our members will need to go through the process to determine their eligibility for coverage. Our members will be required to renew their Medicaid and/or CHIP coverage or risk losing their plan and access to healthcare. TCHP has actively communicated with members about this change...

By Texas Children's Health PlanFacilities, HHSC, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialistsbilling, coverage, Member Eligibility0 CommentsRead more...

09JunJune 9, 2023

Provider Alert! HHSC to Implement Pulmonary Hypertension Agents Clinical Prior Authorization on July 27, 2023

Date: June 9, 2023 Attention: All Providers Effective Date: July 27, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective July 27, 2023, Texas Health and Human Services (HHSC) will be implementing clinical prior authorization criteria for Pulmonary Hypertension Agents. How this impacts providers: Starting July 27, 2023, TCHP will implement the Pulmonary Hypertension Agents clinical prior authorization criteria. Updated prior authorization (PA) forms will be accessible on Navitus. It is crucial for all providers to...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialistsclinical prior authorization, Pulmonary Hypertension Agents0 CommentsRead more...

09JunJune 9, 2023

Provider Alert! Clinical Prior Authorization Criteria Updates

Date: June 9, 2023 Attention: All Providers Effective Date: March 23, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that the Texas Health and Human Services (HHSC) will be implementing updated clinical prior authorization criteria for Allergen extracts, IIleal Bile Acid Transporter (IBAT) Inhibitors and Monoclonal Antibody Agents. Allergen Extracts Palforzia is indicated for an allergic reaction that may occur with accidental exposure to peanut. Palforzia will require clinical criteria similar to that of other allergen extracts. The...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialistsclinical prior authorization, IBAT, Illeal Bile Acid Transporter, Monoclonal Antibody0 CommentsRead more...

09JunJune 9, 2023

Provider Alert! Clinical Criteria Revision for Hereditary Angioedema Agents (HAE) effective June 1,2023

Date: June 9, 2023 Attention: All Providers Effective Date: June 1, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective June 1, 2023, the Texas Health and Human Services (HHSC) added age and diagnosis restriction for HAE agents. Please see the drugs impacted below: DrugProcedure CodeAgeDiagnosisBerinert®J0597≥ 5 yearsD84.1Kalbitor®J1290≥ 12 yearsD84.1Firazyr®J1744≥ 18 yearsD84.1Takhzyro®J0593≥ 2 yearsD84.1 How this impacts providers: Starting June 1 2023, TCHP will have diagnosis and age restrictions for HAE agents including Berinert®, Kalbitor®, Firazyr® and...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, SpecialistsClinical Criteria Revision, HAE, Hereditary Angioedema Agents0 CommentsRead more...

08JunJune 8, 2023

Provider Alert! ARPA HCBS Provider Retention Payments Attestation and Reporting Requirements

Date: June 8, 2023 Attention: STAR Kids Providers providing Home and Community Based Services (HCBS) Deadline for the attestation and reports was extended to August 9, 2023 Call to action: This notice is to inform Home and Community Based Services (HCBS) Providers that Health and Human Services (HHSC) requires providers who deliver eligible HCBS services with service dates between March 1, 2022, and August 31, 2022, to submit an attestation, an initial report, and a final report. The attestation, initial, and final reports...

By Texas Children's Health PlanSpecialistsARPA, HCBS, Provider Retention, Reporting Requirements0 CommentsRead more...

08JunJune 8, 2023

Provider Alert! Temporary Extension to Submit Claim Appeals

Date: June 8, 2023 Attention: All Providers Texas Children’s Health Plan (TCHP) would like to notify providers that the timely filing deadline for claim appeals has been waived for Dates of Service: August 1, 2022 – July 31, 2023. TCHP is conducting a provider reimbursement review to ensure accurate provider payments following the implementation of our new claims processing system, Epic Tapestry, on August 1, 2022. Claims identified with erroneous payments will automatically be adjusted. However, providers may also submit or resubmit appeals...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, SpecialistsClaim Appeals, claims, extension0 CommentsRead more...

08JunJune 8, 2023

Provider Alert! Updates and Actions Required for Implementation of PEMS Master Provider File Regarding Address Differences

Date: June 7, 2023 Attention: All Providers Provider Enrollment Management System (PEMS) effective date: October 25, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that the effective date for PEMS is October 25, 2024. The collaborative testing between managed Care Organizations (MCOs) and Health and Human Services Commission (HHSC) determined that there are some providers with mismatched addresses in PEMS. The providers with these mismatched addresses will receive communication from TCHP. How this impacts providers: The communication from...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, SpecialistsAddress Changes, Master Provider File, PEMS0 CommentsRead more...

01JunJune 1, 2023

Provider Alert! You’re Invited to Our Provider Advisory Group!

Date: June 1, 2023 Attention: All Providers Event dates for the upcoming sessions are based on Service Delivery Area: Tuesday, June 13, 2023 Northeast SDAThursday, June 15, 2023 Jefferson SDATuesday, June 20, 2023 Harris SDAAll sessions will be from 6:00 – 7:30PM CST Call to action: Texas Children’s Health Plan (TCHP) invites you to join our quarterly Provider Advisory Group (PAG). We will hold our next round of sessions later this month and dates are based on Service Delivery Area (SDA) as described above....

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialistspag, provider advisory group, SDA0 CommentsRead more...

01JunJune 1, 2023

Provider Alert! HHSC to Implement Gattex® Clinical Prior Authorization on June 6, 2023

Date: May 31, 2023 Attention: All Providers Effective Date: June 6, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective June 6, 2023, Texas Health and Human Services (HHSC) will be implementing the Gattex® clinical prior authorization criteria, which was approved on April 28, 2023. How this impacts providers: Starting June 6, 2023, TCHP will implement the Gattex® clinical prior authorization criteria. The new criteria is available on the HHSC Vendor Drug Program website and can...

By Texas Children's Health PlanOB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialistsclinical prior authorization, Gattex, hhsc, VDP0 CommentsRead more...

24MayMay 24, 2023

Provider Alert! Clinical Criteria Revision for Evkeeza® effective June 1, 2023

Date: May 18, 2023 Attention: All Providers Effective Date: June 1, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective June 1, 2023, Texas Health and Human Services (HHSC) will expand coverage for Evkeeza® (procedure code J1305) to adolescents 5 years of age and older due to a recent U.S. Food and Drug Administration (FDA) approval. Evkeeza® is an injectable prescription medicine used along with other low-density lipoprotein (LDL) lowering medicines in treating high cholesterol...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialistsclinical criteria, Evkeeza, High Cholesterol, LDL0 CommentsRead more...