Specialists

Articles with relevant information for Specialists.

Provider Alert!
28Jul

Provider Alert! Metabolic Monitoring for Children and Adolescents on Antipsychotics Reminder

Date: October 4, 2021 Attention: Primary Care and Behavioral Health Providers 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) is actively working on a Performance Improvement Project (PIP) for members, ages 1-17, who are taking antipsychotic medications. This PIP is part...

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Provider Alert!
28Jul

Provider Alert! Hypertension intervention campaign, Release the Pressure

Attention: All Providers Effective Date: July 20, 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 invite you to participate in a new campaign, launched by several healthcare organizations, focused on helping black women learn more about...

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Provider Alert!
28Jul

Provider Alert! Age and diagnosis restrictions for Code J0180

Attention: Geneticists Effective Date: July 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) aligns with the Texas Medicaid Provider Procedures Manual (TMPPM) and there is no authorization requirement for Fabrazyme Injection, agalsidase beta Code J0180. TCHP does apply...

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Provider Alert!
27Jul

Provider Alert! Second Quarter 2020 HCPCS Updates for Texas Medicaid

Attention: All Providers Effective Date: July 1, 2020 Updated September 10, 2020 Call to action: Texas Children’s Health Plan (TCHP) aligns with the Healthcare Common Procedure Coding System (HCPCS) additions, revisions, and discontinuations that are implemented for claims processing by TMHP for Texas Medicaid. How this impacts providers: Second Quarter 2020 HCPCS Added Procedure Codes are as follows: Clinician Administered Drug (CAD) Procedure Codes C9061 J0223 J0691* J0742 J0791* (replacing C9053) J0896  J7169* J7204 J9177 J9246 J9358 Q5119 Q5120     The follow codes have age restrictions: J1201 – 6 months and older J1558 – 2 years and older J0791 – 16...

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Provider Alert!
24Jul

Provider Alert! Medicaid drug formulary changes

Attention: All Providers Effective Date: July 31, 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: The Texas Vendor Drug Program (VDP) will implement changes to the state Medicaid drug formulary, effective Thursday, July 30, 2020. Select medications will be moving from “preferred” to “non-preferred” status and...

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24Jul

Provider Alert! COVID- 19 testing information and resources

Attention: All Providers Effective Date: July 24, 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. The following Provider guidance is provided as a TCHP educational communication only. As many of our network providers are affiliated with other institutions and organizations who also set policy and procedure, this communication...

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Provider Alert!
24Jul

Provider Alert! Adakveo Update

Attention: Hematologists Effective Date: July 1, 2020 Call to action: Texas Children’s Health Plan (TCHP) aligns with the prior authorization criteria available in the most recent Texas Medicaid Provider Procedures Manual (TMPPM), Clinician Administered Drugs Handbook. Prior authorization guidelines began May 26, 2020. Adakveo, Injection, crizanlizumab - clinician administered drug HCPCS code C9053 is being replaced with Code J0791. This new Code, J0791 will follow the same prior authorization requirements. Adakveo (Crizanlizumab-tmca) is indicated for members with sickle cell disease to reduce the frequency...

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Provider Alert!
22Jul

Provider Alert! Update to Gait Trainers and Standers Guidelines

Attention: All Providers Effective Date: July 22, 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: This is a reminder that Texas Children’s Health Plan (TCHP) requires authorization of all gait trainers and standers, including all accessories. There is one addition to the guideline, which aligns...

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10Jul

Provider Alert! Current Electronic Visit Verification (EVV) users and Financial Management Services Agencies (FMSAs)

Effective Date: 7/10/2020 Call to action: On June 29, 2020, TMHP made improvements to the Electronic Visit Verification (EVV) Portal, posted a new demonstration of the changes, and updated the related training materials. How this impacts providers: Electronic Visit Verification (EVV) users are encouraged to review the updates and improvements to the Electronic Visit Verification (EVV) Portal and the updated EVV training materials. For more information, see details listed below: Next steps for providers: EVV Portal Updates The EVV Claim Search tab, EVV Visit Details screen, and...

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Provider Alert!
07Jul

Provider Alert! Age Limitation Change for Antisense Oligonucleotides Benefits

Attention: Neurologists Effective Date: For dates of service on or after January 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 prior authorization criteria available in the most recent Texas Medicaid Provider Procedures Manual, Clinician Administered...

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