Specialists

Articles with relevant information for Specialists.

20Aug

Appointment Availability Standards

What are appointment availability standards? How do you as a provider with Texas Children’s Health Plan play a role? In 2015 Senate Bill 760 passed, requiring Texas Health and Human Services Commission (HHSC) to monitor the provider networks of managed care organizations. Texas Children’s Health Plan would like to ensure members are able to schedule appointments with providers in accordance with the HHSC’s appointment accessibility guidelines.   Provider Type Level/Type of Care Appointment Accessibility Standards OB/GYN Low Risk Pregnancies Provided within 14 calendar days High Risk Pregnancies Offered within 5 calendar...

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11Aug

Enhance your adolescent care with SBIRT

It’s back-to-school season, a time when pediatrics offices are busy with well-child checks and sports physicals. Pediatricians are in an excellent position to educate adolescents about their health, including providing guidance about substance use. The AAP advises on universal substance use screening using SBIRT techniques for all adolescents. In lower-risk patients, they can prevent or delay the onset of use. For intermediate-risk patients, they can discourage ongoing use and reduce harm. And they can refer patients who have developed substance...

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25Jul

Updated STAR Kids billing matrix effective June 5, 2017.

Updated STAR Kids billing matrix effective June 5, 2017. Updates include: Registered nurse modifier (TD) to the private duty nursing (PDN) billing code, T1000 Billing codes for PDN independently enrolled LVNs and RNs are included in the matrix Revenue code 663 was added to the out-of-home respite codes. Please note that failure to use this billing matrix will result in denials for incorrectly billed services. For more information on this topic, visit http://www.texaschildrenshealthplan.org/for-providers .

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18Jul

Prior Authorization of Texas Health Steps (THSteps) dental therapy under general anesthesia for members who are six years of age or younger

Effective July 1, 2017, Texas Children’s Health Plan will be required to implement prior authorization for Level 4 deep sedation and general anesthesia provided in conjunction with therapeutic dental treatment for Medicaid dental clients from ages 0 through six years. All Level 4 services must be authorized prior to rendering services. Anesthesia services provided by a dentist should use procedure code D9223. Any anesthesia services provided by an anesthesiologist (M.D./D.O.) or certified registered nurse anesthetist (CRNA), should use procedure code 00170,...

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18Jul

Helping patients access and adhere to antipsychotic medications

A common reason for behavioral health readmission is delay to an outpatient supply of antipsychotic medications. You can help avoid this problem by completing prior authorization documentation before a patient is discharged. Texas Children’s Health Plan follows Texas Medicaid Guidelines for the use and approval of antipsychotics in children. Prior authorization documentation for antipsychotic medications can be found here: https://www.navitus.com/Misc-Pages/PDF-Form-Viewer.aspx?FormID=5264d812-b3d9-45f7-9b7a-a48eefca8adc Providers can ensure patients receive antipsychotic medications at discharge by using the hospital pharmacy or a community pharmacy delivery service. If a patient...

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07Jul

Provider Alert! Changes to Physical, Occupational, and Speech Therapy Benefits for All Ages

Effective for dates of service on or after September 1, 2017, physical therapy (PT), occupational therapy (OT), and speech therapy (ST) benefits for all ages will change for Texas Medicaid. Please review this link for changes to this medical benefit policy that applies to the following: Billing structure changes for PT, OT, and ST services Procedure codes end-dating August 31, 2017 Required modifiers Claims filing changes Clarification to benefits Providers may refer to the current Texas Medicaid Provider Procedures Manual, Physical Therapy, Occupational Therapy, and Speech Therapy...

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17May

TCHP now accepts Outpatient Authorizations for many services online via Clear Coverage effective June 1, 2017!

Tired of faxing authorization requests and medical records? Spending too much time on hold waiting to speak to an Authorization Specialist for non-urgent authorization request? Looking for a faster, more efficient way to submit authorizations? Why not submit your authorizations request through Clear Coverage? What are the benefits? Easy to access 24/7 online access to Clear Coverage Receive real time authorization status by viewing your office’s home page in Clear Coverage Services are immediately uploaded into Texas Children’s Health Plan’s authorization for clinical review Automatic APPROVALS may be...

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17May

Provider Alert! Authorization Extension for STAR Kids Members

Attention STAR Kids Providers May 17, 2017 Authorization Extension for STAR Kids Members The Health and Human Services Commission expects managed care organizations to extend long term services and supports (such as Personal Care Services, Community First Choice, and Private Duty Nursing) authorizations for services until completion of the STAR Kids Screening and Assessment Instrument (SAI), but no longer than July 1, 2017. In order to receive payment for these services, you must have authorization from Texas Children’s Health Plan, and the SAI must be completed by...

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