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Provider Alert!

Provider Alert! Removal of Specialist Requirements from CAD Clinical Policies and Prior Authorization Criteria

Date: July 13, 2022 Attention: Providers Effective Date: August 1, 2022 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event. Call to action: HHSC is updating the prior authorization criteria for some clinician administered drugs. How this impacts providers: HHSC will no longer require the prescription include consultation with or [...]

Provider Alert! Pediatric Updates for Moderna & Pfizer-BioNTech COVID-19 Vaccines

Date: July 12, 2022 Attention: All Providers Effective Date: June 17, 2022 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated with the COVID-19 event. TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event. Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that on June 17, 2022, the U.S. Food and Drug Administration (FDA) authorized emergency use [...]

Provider Alert!

Provider Alert! Prior Authorization Criteria Update for Rinvoq and Cibinqo

Date: June 28, 2022 Attention: All Providers Effective Date: August 31, 2022 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event. TCHP will apply updates and reprocess impacted claims as soon as possible. However, please allow up to sixty (60) business days for reprocessing. Providers are not required to [...]

Provider Alert! Age Range Updates for Drug Procedure Codes Effective April 1

Date: June 8, 2022 Attention: All Providers Effective date: April 1, 2022 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated with the COVID-19 event. TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event. Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that on April 1, 2022, the Health and Human Services Commission (HHSC) updated age ranges [...]

Provider Alert! COVID-19 Pediatric Provider Enrollment

  Date: May 7, 2021 Attention: All Pediatric Providers Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event. Call to action: Texas Children’s Health Plan would like to inform network providers that the Texas Department of State Health Services (DSHS) Immunization Unit is encouraging all pediatric providers to enroll [...]

Provider Alert!

Provider Alert! Annual Utilization Management Notice to All Providers

Attention: All Providers Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event.  Affirmative Statement about Incentives As a reminder, Texas Children’s Health Plan (TCHP) Utilization Management (UM) decision-making is based on our Policies, Procedures, and Guidelines. They are based only on appropriateness of care and service and the [...]

Provider Alert!

Provider Alert! Guidance for Laxatives for Medicaid Members

table { border-collapse: collapse; }tr,td { border: solid thin; } Attention: All Providers Effective Date: September 3, 2020 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event. Call to action: Polyethylene Glycol [PEG] 3350 (generic for Miralax), ClearLax (powdered formulation of PEG 3350) and generic lactulose are all [...]

Provider Alert!

Provider Alert! Continuing Medical Education/Ethics: Neonatal Abstinence Syndrome Awareness Month resources and events online

Attention: All Obstetric Care Providers Effective Date: June 4, 2020 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event. Call to action: In recognition of Neonatal Abstinence Syndrome (NAS) Awareness Month for the month of June, Texas Children’s Health plan (TCHP) would like to inform you of resources [...]

Provider Alert!

Provider Alert! Synagis (palivizumab) removed from Texas Medicaid formulary

Attention: All Providers and Pharmacies Effective Date: April 14, 2020 Call to action: The 2019-2020 respiratory syncytial virus (RSV) season ended April 14 for all counties in Texas. Synagis (palivizumab) has been removed from the Texas Medicaid formulary as of April 14. How this impacts providers: Synagis is unproven for prophylaxis outside of the RSV season. Providers wishing to prescribe Synagis during this time must submit a medical necessity request. Next steps for providers: Providers should continue to follow American Academy of Pediatrics [...]

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 [...]