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Provider Alert!
24Jun

Provider Alert! Texas Children’s Promotes Positive Adolescent Health

Date: June 21,2024 Attention: All Providers Call to action: Texas Children’s Health Plan (TCHP) regards counseling and treatment for adolescent care as extremely important, especially in Behavioral Health. A patient’s impression of their visit directly impacts their compliance with aftercare and overall health outcome. How this impacts providers: The best way for patients to feel they are receiving the best care possible is to have clear communication with their provider by implementing effective clinical practices. Based on the 2023 Experience of Care and...

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Provider Alert!
21Jun

Provider Alert! Update & Revision for Drugs Added to Medicaid, CHIP Formularies

Date: June 21, 2024 Attention: All Providers Effective dates: June 6; June 12, 2024 for ESOMEPRAZOLE MAG DR 20 MG C Call to action: This is an update to communication that was previously posted on June 18, 2024. Texas Children’s Health Plan would like to inform providers that the Vendor Drug Program added the new drugs to the table available below, effective June 6; June 12, 2024 for ESOMEPRAZOLE MAG DR 20 MG C. Background:Vendor Drug Program (VDP) added new NDCs to the Medicaid and...

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Provider Alert!
16May

Provider Alert! National Drug Codes Added to Medicaid, CHIP Formularies

Date: May 16, 2024 Attention: Providers Effective date: May 8 and May 10, 2024 Call to action: Texas Children’s Health Plan would like to inform providers that the Vendor Drug Program added the new drugs to the table available below, effective May 8, 2024, and May 10, 2024. National Drug CodeDrug NameEffective Date00173090442NUCALA 40 MG/0.4 ML SYRINGE5/8/202415370030560POKONZA 10 MEQ PACKET5/8/202464406003002ZURZUVAE 25 MG CAPSULE5/10/202464406003101ZURZUVAE 30 MG CAPSULE5/10/202468682013350CLINDAMYC-BNZ PEROX 1.2-3.75/10/202472786010202OXBRYTA 300 MG TABLET5/10/202472786010203OXBRYTA 300 MG TABLET5/10/202472205018138PIRFENIDONE 267 MG TABLET5/10/202459651020623NITROFURANTOIN 25 MG/5 ML SUSP5/10/202400173089713JESDUVROQ 1 MG TABLET5/10/202400173090313JESDUVROQ...

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Provider Alert!
24Apr

Provider Alert! Annual CMS Drug Utilization Review (DUR) Survey

Date: April 24, 2024 Attention: Medicaid Providers Deadline to complete survey: May 14, 2024 Call to action: The purpose of the communication is to inform prescribers of changes to the annual CMS Drug Utilization Review (DUR) Survey. The survey contains a new, required section of responses related to the Texas Prescription Drug Monitoring Program (PDMP). This year's survey is for data material from Federal Fiscal Year (FFY) 2023 (Oct. 1, 2022, to Sept. 30, 2023). Link to survey: CMS DUR Annual Survey–Provider PDMP Survey How...

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Provider Alert!
23Apr

Provider Alert! Updates to the EVV Visit Maintenance Processes Hold for HHAeXchange System Users for Dates of Service Prior to Go-Live Date

Date: April 23, 2024 Attention: STAR Kids Providers/Consumer Directed Services employers, and FMSA Providers Effective Date: April 22, 2024 Call to action: Effective April 22, Electronic Visit Verification (EVV) program providers, financial management services agencies (FMSAs), and Consumer Direct Services (CDS) employers who use HHAeXchange as their EVV system may now perform visit maintenance processes for dates of service prior to their go-live date with HHAeXchange. For Proprietary System Operators (PSOs), the visit maintenance hold for dates of service prior to go-live with their...

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Provider Alert!
29Feb

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...

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Provider Alert!
26Feb

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...

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Provider Alert!
05Dec

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...

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03Nov

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...

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Provider Alert!
27Sep

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...

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