Specialists

Articles with relevant information for Specialists.

Provider Alert!
13Feb

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...

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Provider Alert!
13Feb

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...

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Provider Alert!
12Feb

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...

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Provider Alert!
12Feb

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...

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Provider Alert!
09Feb

Provider Alert! EVV Claims Matching Bypass from January 1 to March 31, 2024

Date: February 9, 2024 Attention: STAR Kids Providers/Consumer Directed Services employers and FMSA Providers Effective: March 31, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that the Texas Health and Human Services Commission (HHSC) implemented a claim matching bypass on February 1, 2024 — for EVV claims with dates of service from January 1 through March 31 — to be paid without a matching EVV visit. Program providers, financial management services agencies (FMSAs), and Consumer Directed Services...

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Provider Alert!
06Feb

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

Date: February 6, 2024 Attention: All Providers Event dates for the upcoming sessions are based on Service Delivery Area: Tuesday, March 19, 2024 Northeast SDA Thursday, March 21, 2024 Jefferson SDA Tuesday, March 26, 2024 Harris SDA All sessions will be from 12:00-1:30PM 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 next month and dates are based on Service Delivery Area as described above. Click here if you...

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Provider Alert!
02Feb

Provider Alert! Class I Drug Recall Notification: Zenzedi

Date: February 1, 2024 Attention: Providers Effective date: Immediately Call to action: On January 24, 2024, Azurity Pharmaceuticals voluntarily recalled one (1) lot (F230169A) of Zenzedi® CII (dextroamphetamine sulfate tablets, USP) 30 mg due to mislabeled packaging. ProductNDC No.Lot No.Exp. DateShip Dates toWholesalersZenzedi®(dextroamphetaminesulfate tablets, USP)30 mg24338-856-03F230169A2025-0608/23/2023 –11/29/2023 How this impacts providers: Patients who received this medication within the ship dates of 8/23/23-11/29/23 are required to return the medication and receive a replacement.  Next step for Providers: Providers should inform their impacted patients and arrange for the...

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Provider Alert!
02Feb

Provider Alert! Clinical Implementation of Hormonal Therapy Agents Clinical Prior Authorization Effective March 1, 2024

Date: February 1, 2024 Attention: All Providers Effective Date: March 1, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective March 1, 2024, the Texas Health and Human Services (HHSC) will implement clinical prior authorizations to hormonal therapy agents. HHSC will implement criteria for the following procedure codes: J1000   (depo-estradiol cypionate, up to 5mg) J1071   (inj testosterone cypionate, 1 mg) J1380   (inj estradoiol valerate, up to 10 mg) J1950   (inj leuprolide acetate, per 3.75 mg) J1951   (inj leuprolide acetate, fensolvi, 0.25...

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Provider Alert!
01Feb

Provider Alert! Provider Type and Places of Service Update for Procedure Code 96372

Date: February 1, 2024 Attention: All Providers Effective date: January 1, 2024 Call to action: Texas Children’s Health plan (TCHP) would like to make providers aware that effective for dates of service on or after January 1, 2024, injectable medication administration procedure code 96372 may be reimbursed to Texas Health Steps medical providers for services rendered in the office, outpatient hospital and birthing center settings. Next step for Providers: Providers are not required to appeal the claims unless they are denied for additional reasons...

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Provider Alert!
19Jan

Provider Alert! Updated: Medicaid Preferred Drug List and Formulary Changes

Date: January 18, 2024 Attention: All Providers Effective Date: January 26, 2024 This is an update for a communication that was previously posted on 12/18/2023. Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective January  26, 2024, select medication(s) moved from “preferred” or “non-reviewed” to “non-preferred” status. A summary of the changes is included below. Resource: https://www.txvendordrug.com/formulary/preferred-drugs Changes with biggest impact to Texas Children Health Plan members and providers: The drugs listed below were either not previously reviewed (NR)...

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