Uncategorized – The Checkup

27SepSeptember 27, 2023

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

Date: September 26, 2023 Attention: Physicians Effective date: 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 G30.9) AND Prescriber attestation that...

By Texas Children's Health PlanUncategorizedAlzheimer's, clinical criteria, Leqembi0 CommentsRead more...

26SepSeptember 26, 2023

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...

By Texas Children's Health PlanUncategorizedEVV, EVV HHAeXchange, HHAeXchange, Visit Maintenance0 CommentsRead more...

25SepSeptember 25, 2023

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....

By Texas Children's Health PlanUncategorizedCOVID, COVID-19, fda authorization, hhsc, non-approved, vaccines0 CommentsRead more...

28AugAugust 28, 2023

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...

By Texas Children's Health PlanUncategorizedNon-Risked Based Status, QTC, Zynteglo0 CommentsRead more...

28JunJune 28, 2023

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...

By Texas Children's Health PlanUncategorizedEVV, provider alert0 CommentsRead more...

15MarMarch 15, 2023

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...

By Texas Children's Health PlanProvider Alert, Uncategorizedprovider alert0 CommentsRead more...

14FebFebruary 14, 2023

Provider Alert! COVID-19 UPDATE ALERT #4 – Telemedicine Services – Physicians, BH, FQHC and RHC Providers

Date: February 10, 2023 Attention: All providers Effective Date: January 30, 2023 The content in this message on Federally Qualified Health Centers (FQHC) reimbursement for Telemedicine (Physician Delivered) and Telehealth (Non-Physician Delivered) Services as a distant site provider as permanent policy change (per S.B. 670, Texas Legislature, Regular session 2019) ended November 30, 2020 as announced by the Health and Human Services Commission. The content in this message on Rural Health Clinics as telehealth and telemedicine sites will remain in effect through March...

By Texas Children's Health PlanOB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialists, UncategorizedCOVID, COVID-19, telemedicine0 CommentsRead more...

13JulJuly 13, 2022

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 be...

By tcphUncategorizedCADs, Prior Authorization0 CommentsRead more...

12JulJuly 12, 2022

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 of...

By tcphOB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialists, UncategorizedCOVID, moderna, pfizer0 CommentsRead more...

30JunJune 30, 2022

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 appeal...

By Texas Children's Health PlanUncategorizedankylosing spondylitis, atopic dermatitis, Cibinqo, Prior Authorization, Rinvoq0 CommentsRead more...