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Provider Alert!

Provider Alert! Infant Well-Child Visit Reminder

Date: February 28, 2024 Attention: Primary Care Providers Call to action: Texas Children’s Health Plan (TCHP) encourages providers to ensure their infant patients are receiving timely well-child visits and immunizations, in compliance with the Texas Health Steps (THSteps) periodicity schedule. More specifically, visits must be scheduled on or before the patient’s birth month in order for them to be considered compliant with Health and Human Services (HHSC) THSteps requirements.  TCHP is committed to ensuring members recognize the importance of preventive care and...

Provider Alert!

Provider Alert! Updates to Vaccine Administration Procedure Code M0201

Date: February 26, 2024 Attention: All Providers Effective: January 1, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective January 1, 2024, vaccine administration add-on procedure code M0201 may be billed in the home setting with the following procedure codes: 906309063690654906559065690657906589066090661906629067090671906729067390674906779068290685906869068790688906949069790723907329073990740907439074490746907479075690759   M0201 will be payable as an add-on code if billed with any of these vaccines, along with the existing COVID-19 vaccine administration procedure code, if administered inside a client’s home. TCHP will reprocess affected claims submitted with the...

Provider Alert!

Provider Alert! Synagis (palivizumab) Clinical Prior Authorization Forms Updated with Revised Abrysvo Criteria

Date: December 4, 2023 Attention: All Providers Effective date: November 17, 2023 Call to action: On November 17, 2023, Health and Human Services Commission (HHSC) updated the Synagis Standard Prior Authorization Request (HHS Form 1321) to include a step to check for Abrysvo vaccine administration to the client’s mother during 32 to 36 weeks of pregnancy. How this impacts providers: Additional information on Abrysvo Vaccine include the following: Abrysvo is indicated for active immunization of pregnant individuals at 32 through 36 weeks gestational age for...

Provider Alert! 2023 COVID-19 Vaccine Currently Not Covered on Texas Medicaid and CHIP Formulary

Date: November 3, 2023 Attention: All Providers Call to action:  As of November 1, 2023, COVID vaccines are currently unavailable on the Medicaid and CHIP Formulary at this time. Texas Health and Human Services Commission (HHSC) is working on ways to add the COVID-19 vaccines to the pharmacy benefit. Texas Children’s Health Plan (TCHP) will provide more information as it becomes available.  Next steps for providers:   In the meantime, should your patient inquire about the COVID-19 vaccine, please encourage your patients to receive their...

Provider Alert!

Provider Alert! Clinical Criteria for Leqembi® (procedure code J0174) effective November 1, 2023

Date: September 26, 2023 Attention: Physicians Effective date for prior authorization criteria: November 1, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective November 1 2023, the Texas Health and Human Services (HHSC) will be implementing prior authorization criteria for Leqembi® (procedure code J0174) for fee-for-service Medicaid. Leqembi (Lecanemab-irmb) is an amyloid-beta directed antibody indicated for early stages of Alzheimer’s disease. Prior Authorization Requirements: Criteria for Initial Approval: Patient has Alzheimer’s disease (Diagnosis codes: G30.0, G30.1, G30.8 or...

Provider Alert!

Provider Alert! EVV Users Must Complete Visit Maintenance Before They Lose Access on December 22, 2023

Date: September 25, 2023 Attention: STAR Kids Providers/Consumer Directed Services employers, and FMSA Providers Background information: As a reminder, HHAeXchange will go-live for current EVV users that have not on boarded as a proprietary system operator on October. 1, 2023. Call to action: The purpose of this communication is to inform program providers, financial management services agencies (FMSAs) and Consumer Directed Services (CDS) employers transitioning to the new state EVV vendor, HHAeXchange, are responsible for completing all required visit maintenance (including visit maintenance...

Provider Alert! HHSC Does Not Cover Vaccines or Drugs That Do Not Have FDA Approval or Emergency Use Authorization

Date: September 25, 2023 Attention: All Providers Effective date: August 31, 2023 Call to action: The purpose of this communication is to inform providers that Texas Medicaid and CHIP do not cover vaccines or drugs that are not authorized or approved by the U.S. Food and Drug Administration (FDA). Health and Human Services Commission (HHSC) will not cover procedure codes related to COVID-19 vaccine or drugs administration as non-risk payments (NRP) if the COVID-19 vaccines or drugs no longer have FDA approval or authorization....

Provider Alert!

Provider Alert! Non-Risk Based Status for Zynteglo Began July 1, 2023

Date: August 28, 2023 Attention: Physicians Effective Date: July 1, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to let you know that effective July 1, 2023, reimbursement for Zynteglo is non-risk. Zynteglo (procedure code J3590) is a gene therapy for treating adult and pediatric clients with beta-thalassemia requiring regular blood cell (RBC) transfusions. How this impacts providers: Zynteglo is administered in a qualifying treatment center (QTC) for clients that meet prior authorization criteria. QTC is required to send the prescription to...

Provider Alert!

Provider Alert! UPDATED: New EVV Vendor System HHAeXchange Launching October 1, 2023

Date: June 28, 2023 Attention: All Providers Effective Date: October 1, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that a new single state funded Electronic Visit Verification (EVV) vendor system, HHAeXchange, is launching October 1, 2023. On April 26, 2022, the Texas Health and Human Services Commission (HHSC) posted a solicitation for EVV System Management Services. Through a competitive selection process, HHSC has selected Accenture State Healthcare Services LLC. How this impacts providers: Accenture will continue to...

Provider Alert! TCHP Psychotropic Medication Utilization Review (PMUR

Date: March 14, 2023 Attention: Pediatricians, Psychiatrists Call to action: Texas Children’s Health Plan (TCHP) utilizes a PMUR program to promote safe prescribing of behavioral health medications to children and adolescents. TCHP identifies potential “prescribing outliers” using parameters established by the Texas Health and Human Services (HHSC). This does not mean the prescribing is wrong or harmful to the child, but requires additional review due to potential for adverse reactions, polyprescribing, and other implications. Who is identified for review? Members under the age of...