Specialists

Articles with relevant information for Specialists.
07Apr

Inpatient Authorization Requests through Clear Coverage

Texas Children’s Health Plan is excited to announce the upcoming implementation of Clear Coverage for inpatient authorization requests beginning May 1, 2017. Clear Coverage is a web-based system that provides an automated method for providers and health plans to manage authorizations for inpatient services at the point of decision. Clear Coverage enables automated authorization, notification, eligibility and direction of members to in-network service providers. Clear Coverage provides the following benefits: Providers have immediate access to coverage, medical appropriateness and network rules,...

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15Mar

Meet Our New President

Lou Fragoso has been appointed president of Texas Children’s Health plan. He joined Texas Children’s Pediatrics in February 2014 and was vice president of Business Operations. Prior to joining Texas Children’s, Lou was in leadership roles at Baylor College of Medicine in Houston and at Lurie Children’s Hospital in Chicago. Lou is a Certified Public Accountant with over 20 years of healthcare finance and management experience. Since joining Texas Children’s Pediatrics, Lou spearheaded the creation of Texas Children’s Urgent Care. Texas...

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14Mar

New Texas Children’s Health Plan provider portal features added

Texas Children’s Health Plan has been actively adding new features to the provider portal located at www.tchp.us/providers Providers can continue to view eligibility, claim status, authorizations and all of our provider news. In addition, providers are able to view the named Service Coordinator for STAR Kids members and submit claim appeals online. The named Service Coordinator for STAR Kids members can be found on the member enrollment information screen under additional information. The Texas Children’s Health Plan Service Coordinator serves as the...

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12Mar

Attention: Star Kids Providers: Prior Authorization required on all Vendor Drug Program (VDP) identified medications

Texas Children’s Health Plan requires prior authorization (PA) on all medications on the VDP website prior to dispensing to members. To obtain a list of medications requiring prior authorization, visit the VDP website at: http://www.txvendordrug.com/formulary/preferred-drugs.shtml Providers can also view instructions on accessing and using the formulary at the Texas Children’s Health Plan website: http://www.thecheckup.org/2016/06/09/do-you-know-how-to-access-the-texas-childrens-health-plan-formulary/ Providers can submit PA documentation to Texas Children’s Health Plan’s pharmacy benefit manager, Navitus. PA forms can be found here: https://www.navitus.com/texas-medicaid-star-chip/prior-authorization-forms.aspx Prior authorizations need to be submitted to Navitus by faxing to...

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13Feb

What is the role of STAR Kids Service Coordinators?

A Service Coordinator is the central contact between Texas Children’s Health Plan and a member’s providers and family members. The purpose of a Service Coordinator is to maximize a Member’s health, wellbeing and independence. The Service Coordinator must work with the Member’s PCP to coordinate all of a member’s health services. The STAR Kids Service Coordinator also engages as an advocate and intervenes on behalf of the member if approved by the member. The Service Coordinator will perform an overall evaluation...

By Facilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialists, , , , , 0 CommentsRead more...
13Feb

AAP Strongly Advises Against Codeine for Children

The American Academy of Pediatrics (AAP) has recently released a Clinical Report strongly advising against codeine use in children. The rationale of the AAP is as follows: “Codeine is a prodrug with little inherent pharmacologic activity and must be metabolized in the liver into morphine, which is responsible for codeine’s analgesic effects. However, there is substantial genetic variability in the activity of the responsible hepatic enzyme, CYP2D6, and, as a consequence, individual patient response to codeine varies from no effect to...

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03Feb

Screening for Maternal Depression – Essential to Child Well Being

Effective January 1, 2017, Texas Children’s Health Plan will reimburse providers for maternal depression screening conducted at a well-child visit. Postpartum depression screening utilizing the Edinburgh Postnatal Depression Scale may be reimbursed up to 2 times per member ages 0-6 months, using CPT code 96161. Code 96161 is used to report the use of a standardized instrument to screen for health risks in the caregiver for the benefit of the patient. The reimbursement for this code will be based on...

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01Feb

HEDIS Spotlight: Prenatal / Postpartum Care

HEDIS stands for Healthcare Effectiveness Data and Information Set. It is a widely used set of performance measures by the nation’s health plans, and an essential tool in ensuring that our members are getting the best healthcare possible. It is extremely important that our providers understand the HEDIS® specifications and guidelines. In this section of The Checkup we will highlight different HEDIS metrics. We will provide a description of the measures, the correct billing codes to support services rendered and...

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25Oct

Upcoming Texas Children’s Health Plan Provider TouCHPoint portal changes: Provider Attestation required

The Texas Children’s Health Plan Provider portal is changing. In order to be compliant with HHSC guidelines to confirm provider demographic information, the Texas Children’s Health Plan Provider portal will require a quarterly attestation of information by NPI number. If access to the secure portal has been blocked because of needed attestation, users will not be able to access the portal until an office administrator for the account attests the information on file. Only staff with office administrator-level access can provide...

By Office Managers, Primary Care Providers, Specialists, , 0 CommentsRead more...
21Sep

Undescended Testicles and the Use of Ultrasound

Cryptorchidism or undescended testis (UDT) is the most common urological birth defect, occurring in 1 in 33 live male births. The most important reasons for surgical treatment of cryptorchidism include increased risks of testicular malignancy, infertility, testis torsion and/or inguinal hernia. The current standard of treatment for any UDT that fails to spontaneously descend by 6 months of age in the United States is orchidopexy (surgery to reposition the testis to the scrotum). Evaluation of UDT includes a thorough gestational...

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