Specialists

Articles with relevant information for Specialists.

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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Provider Alert!
16Jan

Provider Alert! Individual Service Plans (ISPs) are now available from the Provider Portal!

Date: January 8, 2024 Attention: Financial Management Service Agencies (FMSA) Providers Call to action: Texas Children’s Health Plan (TCHP) is pleased to announce that our STAR Kids member’s Individual Service Plans (ISPs) are now available from the provider portal. Revisions to ISPs related to the provider rate changes were completed on December 30, 2023 and FMSAs can use this link below to access them. Steps for accessing the ISPs are as follows: Tapestry Link user logs into Texas Children’s® Link.  Accessible here https://epiccarelink.texaschildrens.org/EpicCareLink/common/epic_login.aspFor more...

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Provider Alert!
12Jan

Provider Alert! Update to Therapeutic Optometry Billing Services for CPT Code 65778

Date: January 12, 2023 Attention: Therapeutic Optometrists Effective: April 11, 2024 Call to action: Effective for dates of service on or after April 11, 2024, therapeutic optometrists are to bill with taxonomy code 152WV0400X (optometry vision therapy) when billing for placement of amniotic membrane on the ocular surface; without sutures, CPT code 65778. Next steps for providers: Providers should verify they are enrolled through Texas Medicaid & Healthcare Partnership (TMHP) under the therapeutic optometry taxonomy with code 152WV0400X in order for claims to process...

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Provider Alert!
09Jan

Provider Alert! Psychosocial Care Interventions as First-Line Treatment for Children and Adolescents

Date: January 8, 2023 Attention: Behavioral Health Providers Call to ActionTexas Children Health Plan (TCHP) encourages providers to continue to take measures to ensure your patients, our members, receive excellent care. TCHP is committed to optimizing the quality of care provided to our members with behavioral health condition(s). TCHP would like to share information on first-line psychosocial care recommendations for children and adolescents before and along with prescribing antipsychotics. Why it MattersAntipsychotic medications are frequently prescribed for nonpsychotic conditions, for which psychosocial care...

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08Jan

Provider Alert! Addition of Paxlovid (Pfizer Oral Covid-19 Drug) to Formulary

Date: January 8, 2024 Attention: Providers Effective date: January 4, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective January 4, 2024, the Texas Health and Human Services (HHS) added Paxlovid to the formulary. Paxlovid (nirmatrelvir co-packaged with ritonavir) is an oral antiviral tablet, is indicated for the treatment of mild-to-moderate COVID-19 in adults who are at high risk for progression to severe COVID-19, including hospitalization or death. How this impacts providers: Please see below for the list...

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