HEDIS Spotlight

HEDIS® (Healthcare Effectiveness Data and Information Set) is a widely used set of performance measures that ensures our members are getting the best health care possible. It is extremely important that our providers understand HEDIS® specifications and guidelines. This section highlights different HEDIS metrics in addition to providing descriptions of the measures, correct billing codes to support services rendered, and tips to direct you to corresponding resources and tools. MEASURE: FOLLOW-UP AFTER HOSPITALIZATION FOR MENTAL ILLNESS MEASURE DESCRIPTION: Members 6 years [...]

May is Mental Health Awareness Month

May is Mental Health Awareness Month Year after year, more and more Americans face the reality of living with a mental illness. Despite their age, many young children show early signs of mental illness. These mental health problems are often clinically diagnosable, and can be a product of the interaction of biological, psychological, and social factors. “Half of all mental health disorders show first signs before a person turns 14 years old, and three quarters of mental health disorders begin [...]

Be a HEDIS HERO for Childhood Wellness

The National Committee for Quality Assurance (NCQA) is a non-profit organization that measures the quality of healthcare across large populations. NCQA does this through its Health Effectiveness and Data Set, also known as HEDIS. HEDIS measures are a set of evidence based standards that Texas Children’s Health Plan is committed to improving upon in order to provide the best care for our members. Making changes across your patient population is easier than you think! In fact, you can become a [...]

Provider Alert!

Provider Alert! Financial Management Service Agency (FMSA)

Subject: Financial Management Service Agency(FMSA) Registration is now open for the Annual Financial Management Service Agency (FMSA) training scheduled for September 19, 2017, 8:30am-5:00pm. This training is mandatory for FMSAs per contracting requirements in Texas Administrative Code, Rules 41.301 and 49.302. In order to comply with this requirement. This required training is now offered in two formats: the FMSA may choose to either attend in-person or by webinar. The in-person training will be at the Winters building located at 701 W. 51st St., Austin, [...]

Texas Children’s Health Plan CMOs introduces STAR Kids

Over the past year and a half, the Texas Children’s Health Plan has been preparing for STAR Kids. This program will offer families with medically complex children the advantage of increased care coordination as part of Medicaid Managed Care. Some of the incredible numbers: 250+ new care coordinators hired and trained by Texas Children’s Health Plan 2,000 new providers added to our network 30,000 new members expected STAR Kids will offer providers additional support and help to reduce the many hassles we run [...]

Changes to the Sterilization Consent Form and Instructions, Approval Process, and Denial Letter

Changes to the Sterilization Consent Form and Instructions, Approval Process, and Denial Letter Information posted July 15, 2016 Note: This article applies to transactions submitted to TMHP for processing. For transactions processed by a Medicaid managed care organization (MCO), providers must refer to the MCO for information about benefits, limitations, prior authorization, and reimbursement. Effective September 1, 2016, the following changes will be made to the Sterilization Consent Form and corresponding instructions, the Sterilization Consent Form Denial Letter, and the process that [...]