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Provider Alert!

Provider Alert! Attention: NCQA HEDIS Measure Changes

Attention: PCP, OB/GYN and Endocrinologist Providers Effective Date: January 1, 2020 Call to action: Texas Children’s Health Plan (TCHP) would like to inform you of changes to the National Committee for Quality Assurance (NCQA) HEDIS Technical Specifications released on July 1st, 2020. How this impacts providers: These changes are effective as of January 1, 2020. Please submit all claims timely, as soon as services are rendered, and use appropriate codes to reflect the services provided particularly for Well-Care Visits and THSteps. REVISED MEASURES Well-Child Visits [...]

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! Texas Health Steps (THSteps) and CHIP medical checkups via remote delivery

Attention: All Providers and Pharmacies Effective Date: Dates of Service May 7, 2020 – January 21, 2021   The content in this message will remain in effect through the public health emergency period, extended to January 21, 2021, as announced by the U.S. Health and Human Services Department. COVID-19 Utilization Management Procedure and TCHP provider alerts can be found here: http://www.thecheckup.org/provider-alerts/ Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP [...]

Provider Alerts! CHIP co-pays waived for office visits in response to COVID-19

Attention: All Providers Effective Date: March 13, 2020 The content in this message will remain in effect until further notice. TCHP COVID-19 Utilization Management Procedure and provider alerts can be found here: http://www.thecheckup.org/provider-alerts/ 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: To help families in accessing [...]

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 [...]

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 [...]