Specialists

Articles with relevant information for Specialists.

Provider Alert!
15Jun

Provider Alert! New Federal Enhanced Provider Relief Funds for Medicaid and CHIP Providers

Attention: All Providers Effective Date: June 10, 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 you of new federal Enhanced Provider Relief Funds for Medicaid and CHIP providers. Here are the details: Beginning June 10, eligible...

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Provider Alert!
12Jun

Provider Alert! Positive Pressure Airway (PAP) device guideline

Attention: All Providers Effective Date: June 17, 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: TCHP would like to inform you of recent updates to the guidelines for home health, speech therapy, and positive pressure airway (PAP) devices. Updates include the following: Home health guideline:...

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Provider Alert!
12Jun

Provider Alert! Updates to Behavioral Health Inpatient and Outpatient Testing Evaluations

Attention: Behavioral Health Providers and Inpatient Facilities Effective Date: January 1, 2019 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: Effective January 1, 2019, the benefit criteria for psychological, neurobehavioral, and neuropsychological testing for inpatient behavioral health and outpatient mental health services has changed for...

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Provider Alert!
12Jun

Provider Alert! Updated reimbursement information for Inpatient Genetic Services

Attention: Geneticist Effective Date: May 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: TCHP would like to inform you of a recent update to the reimbursement information for inpatient genetic service codes 99254 and 99255. Effective for dates of service on or after...

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Provider Alert!
10Jun

Provider Alert! Update: Updates to Prior Authorization Requirements

Attention: All Providers Effective Date: June 4, 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: TCHP would like to inform you of recent updates to the prior authorization requirements and the effective dates. Updates include the following:  Medical services now requiring prior authorizations:  Therapeutic Continuous Glucose Monitors-...

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Provider Alert!
10Jun

Provider Alert! COVID-19/Hydroxychloroquine Prescribing Revised Update from April 2, 2020

Attention: All Providers and Pharmacies Effective Date: June 9, 2020 Call to action: The Texas State Board of Pharmacy has modified the emergency basis rule when dispensing prescriptions for chloroquine, hydroxychloroquine, mefloquine, and azithromycin.  Physicians no longer have to include the diagnosis on the prescription. Additionally, the rule does not prevent a physician from prescribing one of these drugs for an off-label use.    How this impacts providers and pharmacies:  A diagnosis is no longer required to be provided on prescriptions for the above medications. Prescriptions may be written for off-label use.    Next...

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Provider Alert!
08Jun

Provider Alert! Nitrofurantoin Oral Suspension Drug Shortage

Attention: All Providers and Pharmacies Effective Date: June 12, 2020 Call to action: Drug shortages of nitrofurantoin oral suspension have been identified on the Medicaid and CHIP formularies.  There is only one National Drug Code (NDC) available on the market, and it is not on the Medicaid formulary. There are many other antibiotic choices available on the formulary and prescribers may choose an appropriate alternative based on patient diagnosis and indication for use. How this impacts providers:  Members may reach out to providers...

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Provider Alert!
08Jun

Provider Alert! Texas Medical Board Emergency Rule re: Issuance of Prescriptions During COVID-19 Pandemic

Attention: All Providers and Pharmacies Effective Date: June 12, 2020 Call to action: On June 5, 2020, the Texas Medical Board's (TMB) Executive Committee, with advice and direction from the Governor's Office, adopted rules on an emergency basis related to the issuance of certain prescriptions during the COVID-19 disaster. The emergency rule prohibits treatment of chronic pain with scheduled drugs through use of telemedicine medical services unless: i) a patient is an established chronic pain patient of the physician and is seeking telephone refill of an...

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Provider Alert!
05Jun

Provider Alert! Metformin ER drug recall due to NDMA impurity (Amneal Pharmaceuticals)

Attention: All Providers and Pharmacies Effective Date: June 4, 2020 Call to action: Amneal Pharmaceuticals LLC has issued a voluntary recall of several lots of Metformin Hydrochloride Extended Release Tablets USP 500mg, and 750mg. Amneal’s Metformin Hydrochloride Immediate Release Tablets are not affected by this recall. The recall is due to discovery of an impurity (N-nitrosodimethylamine [NDMA]) in the finished product. NDMA is classified as a probable human carcinogen that may be found in certain foods, drinking water, and industrial processes. Amneal has...

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Provider Alert!
03Jun

Provider Alert! Financial Management Services Agencies (FMSA)

Attention: Financial Management Services Agencies (FMSA) Subject: Cures Act EVV: The EVV Practice Period Begins July 1 Effective Date: 7/1/2020 Call to action: From July 1, 2020, through November 30, 2020, an Electronic Visit Verification (EVV) practice period will allow program providers and financial management services agencies (FMSAs) impacted by the 21st Century Cures Act to practice using the EVV system, EVV Portal, and EVV claims matching. Consumer directed services (CDS) employers can practice using the EVV system. EVV claims will not be denied...

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