Specialists

Articles with relevant information for Specialists.
03Dec

Provider Alert! New Online Authorization Platform for Providers

Attention: All Providers Effective Date: January 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 (TCHP) would like to inform our network providers that currently have access to Clear Coverage, our online authorization tool, that beginning January 1, 2021; Clear...

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30Nov

Provider Alert! Utilization Management COVID-19 Procedure Update

Attention: Therapy, LTSS, Private Duty Nursing, and DME Service Providers        Effective Dates: December 1, 2020 and March 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 (TCHP) would like to inform network providers of the following updates made to the...

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Provider Alert!
30Nov

Provider Alert! Benefit reminder and Prior Authorization Update for Spravato

Attention: Behavioral health Providers Effective Date: January 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 (TCHP) aligns with the Health and Human Services Commission (HHSC) on the revised prior authorization criteria for Spravato (Esketamine). Effective January 1, 2021, HHSC...

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Provider Alert!
30Nov

Provider Alert! Medically Dependent Children Program Waiver (MDCP) Eligibility Process and Peer-to-Peer Review

Attention: Primary Care Providers and Sub Specialists  Effective Date: December 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: Per Texas Health and Human Services Commission (HHSC) contract changes effective December 1, 2020, Texas Children’s Health Plan (TCHP) would like to inform network providers...

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Provider Alert!
24Nov

Provider Alert! Zolgensma Update – new TMPPM criteria pending publication

Attention: Neurologists and SMA specialists Effective Date: December 1, 2020  Call to action:  Prescribers should be aware of an update to prior authorization criteria for Zolgensma (onasemnogene abeparvovec) drug HCPCS code J3399. Zolgensma is indicated for treatment of pediatric patients (<2 years of age) with Spinal Muscular Atrophy (SMA). Effective December 1, diagnosis of Type I SMA (diagnosis code G120) will require three or less copies of SMN-2. Previous criteria required two or fewer copies. All other criteria will remain the same. How this impacts providers:...

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Provider Alert!
19Nov

Provider Alert! Updates to Prior Authorization Requirements for Genetic Testing, Wheelchair accessory, and Personal Care Services

Attention: All providers Effective Date: March 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 (TCHP) would like to inform network providers of services that require a prior authorization effective March 1, 2021. Genetic Testing Codes: 81202 APC (adenomatous polyposis coli) (eg,...

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Provider Alert!
19Nov

Provider Alert! Updates to Prior Authorization Requirements for CADs, electronic bone growth stimulators, home telemonitoring, and hospital beds

Attention: All providers Effective Date: February 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 (TCHP) would like to inform network providers of Prior Authorization updates. Clinician Administered Drugs (CAD) that require a prior authorization effective February 1, 2021: 90378, Synagis-...

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Provider Alert!
10Nov

Provider Alert! HHSC Texas Behavioral Health Services Survey

Attention: Behavioral Health Providers    Effective Date: Survey is available until November 21, 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) would like to inform network Behavioral Health providers of a recent survey the Health and Human Services Commission (HHSC)...

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Provider Alert!
06Nov

Provider Alert! Benefits for Telemedicine Services and Telehealth Services to Change for Texas Medicaid December 1, 2020

Attention: FQHCs and  School-based Clinics Effective Date: For dates of service on or after December 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 the changes to telemedicine (physician-delivered) services and telehealth (non-physician delivered) services include reimbursing...

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Provider Alert!
06Nov

Provider Alert! Peer Specialist Services Became a Benefit of Texas Medicaid January 1, 2019

Attention: Behavioral Health Providers Effective Date: October 28, 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) would like to inform providers that Code H0038 is a benefit of Texas Medicaid for members 21 years of age and older effective,...

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