Specialists

Articles with relevant information for Specialists.

Provider Alert!
08Dec

Provider Alert! Yescarta Prior Authorization Criteria Update

Date: December 7, 2021 Attention: Oncologists Effective Date: November 1, 2021 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 updated the clinical prior authorization criteria for Yescarta (procedure code Q2041) to align with the recent FDA indication expansion and guidance from the...

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Provider Alert!
29Nov

Provider Alert! Well Child and Texas Health Steps Visit reminder

Date: November 22, 2021 Attention: PCP, OB/GYN and Endocrinologist Providers Call to action: Texas Children’s Health Plan (TCHP) would like to remind you of the National Committee for Quality Assurance (NCQA) HEDIS Technical Specifications. How this impacts providers: Please submit all claims timely, as soon as services are rendered, and use appropriate codes to reflect the services provided particularly for Well-Care Visits and THSteps. Well-Child Visits in the First 30 Months of Life (W30) Two rates will be measured: Well-Child Visits in the First 15 Months: Six...

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Provider Alert!
19Nov

Provider Alert! Texas Medicaid and Healthcare Partnership (TMHP) Provider Enrollment and Management System (PEMS)

Date: November 29, 2021 Attention: All Providers Effective Date: December 13, 2021 for PEMS Webinar date: December 7, 2021 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 would like to remind providers that the Texas Medicaid & Healthcare Partnership’s (TMHP) Provider Enrollment and...

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Provider Alert!
18Nov

Provider Alert! JW Modifier Update

Date: November 18, 2021 Attention: All Providers 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) aligns with Texas Medicaid and Healthcare Partnership (TMHP) regarding the reimbursement policy for the unused portion of a single use vial...

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17Nov

NEW Provider Scorecard – Empowering providers to maximize the impact of their services

NEW Provider Scorecard – Available for all Primary Care Physicians Texas Children’s Health Plan has created the Provider Scorecard to equip primary care physicians with metrics that will help maximize the value of their services while optimizing costs. The Provider Scorecard contains key information regarding Quality, Service and Cost metrics. By placing this data under one location, Texas Children’s Health Plan is giving PCPs the opportunity to take actionable steps towards a better outcome for them, the health plan, and our...

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09Nov

Provider Alert! Update to COVID-19 Monoclonal Antibody Therapy Administration Codes M0245 and M0246

Date: January 3, 2022 Attention: All Providers Subject: Update to COVID-19 Monoclonal Antibody Therapy Administration Codes M0245 and M0246 Effective Date: Dates of service on or after December 3, 2021 for age range expansion 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: On December 3, 2021, the...

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Provider Alert!
09Nov

Provider Alert! Update to the Durable Medical Equipment and Supplies Handbook

Date: November 4, 2021 Attention: Durable Medical Equipment, Primary Care, and Gastroenterologist Providers Effective Date: November 1, 2021 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: On November 1, 2021, Texas Medicaid Health Partnership (TMHP) will update the Texas Medicaid Provider Procedures Manual, Durable Medical Equipment...

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Provider Alert!
01Nov

Provider Alert! Abecma available on Medicaid formulary with prior authorization requirements

Date: October 26, 2021 Attention: Oncologists Effective Date: October 1, 2021 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: Prescribers should be aware that Abecma (procedure code C9081) will be available to members through Texas Medicaid pharmacy benefit effective October 1, 2021. Access will require meeting...

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Provider Alert!
01Nov

Provider Alert! Breyanzi available on Medicaid formulary with prior authorization requirements

Date: October 26, 2021 Attention: Oncologists Effective Date: October 1, 2021 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: Prescribers should be aware that Breyanzi (procedure code Q2054) will be available to members through Texas Medicaid pharmacy benefit effective October 1, 2021. Access will require meeting...

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01Nov

Provider Alert! CME event is coming up. Register Today!

CME: Identifying and Responding to Human Trafficking Recognize the scope and impact of human trafficking and what physicians and other care professionals can do to help victims and support resources available. Wednesday, November 17, 2021 - 5:30 p.m. – 7:30 p.m. – Live stream via WebEx CME Objectives: Discuss the scope, diversity, and types of human trafficking in the United States Recognize vulnerability factors and identification of human trafficking victims to improve health outcomes Apply trauma informed techniques to enhance interactions with potential victims of human...

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