Provider Alerts

Provider Alert! Coverage of Commercialized COVID-19 Vaccines Begins as a Pharmacy Benefit

Effective Dates: As of September 11, 2023 & October 3, 2023 Date: December 4, 2023 Attention: All Providers Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective for dates of service on or after September 11, 2023 and October 3, 2023, the U.S. Food and Drug Administration’s (FDA) issued […]

Provider Alert! Non-Formulary Requests for Obesity Control Drugs

Date: April 28, 2023 Attention: All Providers Effective Date: March 1, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective March 1, 2023, the Health and Human Services Commission (HHSC) will no longer approve medically necessary non-formulary drug requests for obesity control drugs for individuals 21 years and […]

Provider Alert! RSV Fall/Winter Traditional Season Regional Changes Begin October 17

Date: October 17, 2022 Attention: All Providers  Effective Date: October 17, 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. […]

Provider Alert! Medicaid Preferred Drug List and Formulary Changes

Date: July 6, 2022 Attention: All Providers Effective Date: July 28, 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. […]

Provider Alert! Breyanzi available on Medicaid formulary with prior authorization requirements

Date: October 26, 2021 Attention: Oncologists Effective Date: October 1, 2021 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 […]

Provider Alert! New prior authorization requirements for Burosumab-Twza(Crysvita)

Attention: Nephrologists and Endocrinologists Effective Date: 1/6/2021 Call to action: Texas Children’s Health Plan (TCHP) is aligning prior authorization criteria for burosumab-twza (Crysvita), J0584, with the Texas Medicaid Provider Procedures Manual (TMPPM). Crysvita is a clinician administered drug indicated for members with X-linked hypophosphatemia (XLH) and Fibroblast Growth Factor 23 (FGF23)-related hypophosphatemia. Below are the […]

Provider Alert! Concerta® to return to non-preferred status

Attention: All Providers Effective Date: October 16, 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: The […]

Provider Alert! COVID-19/Pharmacy Revised Update from June 8, 2020

Attention: All Providers and Pharmacies Effective Date: June 24, 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: […]

Provider Alert! COVID-19/Hydroxychloroquine Prescribing Revised Update from April 2, 2020

Attention: All Providers and Pharmacies Effective Date: June 9, 2020 Call to action: The Texas State Board of Pharmacy has modified the emergency basis rule when dispensing prescriptions for chloroquine, hydroxychloroquine, mefloquine, and azithromycin.  Physicians no longer have to include the diagnosis on the prescription. Additionally, the rule does not prevent a physician from prescribing one of […]

Provider Alert! Nitrofurantoin Oral Suspension Drug Shortage

Attention: All Providers and Pharmacies Effective Date: June 12, 2020 Call to action: Drug shortages of nitrofurantoin oral suspension have been identified on the Medicaid and CHIP formularies.  There is only one National Drug Code (NDC) available on the market, and it is not on the Medicaid formulary. There are many other antibiotic choices available […]

Provider Alert! Texas Medical Board Emergency Rule re: Issuance of Prescriptions During COVID-19 Pandemic

Attention: All Providers and Pharmacies Effective Date: June 12, 2020 Call to action: On June 5, 2020, the Texas Medical Board’s (TMB) Executive Committee, with advice and direction from the Governor’s Office, adopted rules on an emergency basis related to the issuance of certain prescriptions during the COVID-19 disaster. The emergency rule prohibits treatment of chronic pain […]

Provider Alert! Metformin ER drug recall due to NDMA impurity (Amneal Pharmaceuticals)

Attention: All Providers and Pharmacies Effective Date: June 4, 2020 Call to action: Amneal Pharmaceuticals LLC has issued a voluntary recall of several lots of Metformin Hydrochloride Extended Release Tablets USP 500mg, and 750mg. Amneal’s Metformin Hydrochloride Immediate Release Tablets are not affected by this recall. The recall is due to discovery of an impurity […]

Provider Alert! Continuing Education Credit: Immunizations

Attention: Primary Care Providers and Pharmacists Effective Date: May 18, 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 […]

Provider Alert! COVID-19 Medicaid Pharmacy Benefit Updated May 4, 2020

Attention: All Providers and Pharmacies Effective Date: May 4, 2020 The Texas Vendor Drug Program (VDP) has implemented several changes in response to COVID-19. This notice contains the latest updates, as well as links to the previously implemented changes. No-auto prior authorization (NAP) designation temporarily lifted: Normally, medications listed as NAP on the drug formulary […]

Provider Alert! VDP Formulary Updates – Update 3

Attention: All Providers and Pharmacies Effective Date: April 21, 2020 Call to action: VDP temporarily revised the preferred drug list to address reported possible drug shortages. A new claims processing edit has also been added to prevent overutilization of antimalarial drugs. Expanded NDCs: The non-preferred status of certain generic formulation NDCs were temporarily removed. The […]

Provider Alert! Issues with EpiPen, Epi-Pen Jrs, and related generic products

Attention: All Providers and Pharmacies Effective Date: April 21, 2020 Call to action: The FDA is alerting stakeholders that EpiPen 0.3mg and EpiPen Jr 0.15mg auto-injectors, and authorized generic versions, may potentially have delayed or inappropriate injecting. Reasons for failure include: Device failure from spontaneous activation caused by using sideways force to remove the blue […]

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 […]

Provider Alert! Pharmacy Updates Related to COVID-19

Attention: All Providers and Pharmacies Effective Date: March 20, 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 […]

Provider Alert! URGENT – Makena (hydroxyprogesterone caproate) formulary change

Attention: OB providers Subject: URGENT – Makena (hydroxyprogesterone caproate) formulary change Effective Date: January 30, 2020   Call to action: The Texas Vendor Drug Program (VDP) will implement changes to the state Medicaid drug formulary, effective Thursday, January 30, 2020. Brand Makena formulations (intramuscular solution for injection, and subcutaneous auto-injectors) will remain on the preferred […]

Medication Synchronization Plan

Effective September 1, 2018, Texas Children’s Health Plan members can receive the Medication Synchronization benefit that will allow them to pick up all of their prescription medication refills on a single day each month, rather than having to go to the pharmacy multiple times per month. The coordination of refills is proven to lead to […]

Need Help Navigating Pharmacy Prior Authorizations?

Pharmacy Prior Authorizations (PAs) can be a difficult administrative burden for providers and staff, however, they help ensure patients are receiving the most evidence-based, cost-effective medications. The Vendor Drug Program (VDP) is the state resource for the Texas Medicaid formulary and Preferred Drug List (PDL).  VDP has provided a very helpful guide to managing pharmacy […]

Provider Alert! STAR Kids Prescription/Pharmacy Prior Authorizations Reinstated 4/15/17

PRESCRIPTION PRIOR AUTHORIZATION NOTIFICATION Subject: STAR Kids Prescription/Pharmacy Prior Authorizations Reinstated 4/15/17 Effective 4/15/17, Texas Children’s Health Plan (TCHP) will enforce pharmacy prior authorization (PA) requirements for STAR Kids members STAR Kids members who received a prescription between 11/1/16-4/15/17 were not subject to normal PA requirements. PA requirements were temporarily lifted during this period to […]

Provider Alert! Early Childhood Intervention (ECI) and Telehealth Services are not required to Use EVV

Date: April 17, 2024 Attention: Early Childhood Intervention and Telehealth Service Providers Effective date: January 1, 2024 Call to action: The purpose of this communication is to inform applicable service providers that Early Childhood Intervention (ECI) and home health services delivered via Telehealth are not required to use EVV for dates of service on or […]

Provider Alert! Fee-for-Services (FFS) Telephone (Audio-Only) Telemedicine Services for Non-Behavioral Health Conditions

Date: December 7, 2023 Attention: All Providers Effective for dates of service on or after November 1, 2023 Call to action: The purpose of this communication is to offer information about the implementation of a new telemedicine services delivery method for certain non-behavioral health conditions. How this impacts providers: The following office and other outpatient […]

Provider Alert! Telemedicine and Telehealth Benefit Updates for Rural Health Clinics and Federally Qualified Health Centers Effective November 1, 2023

Date: November 7, 2023 Attention: Rural Health Clinics and Federally Qualified Health Centers Effective date: November 1, 2023 Call to action: The purpose of this communication is to provide guidance on the implementation of a new telehealth patient site facility fee benefit for federally qualified health center (FQHC) and rural health clinic (RHC) providers. How […]

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 […]

Provider Alert! Telemedicine/Telehealth claims guidance Provider Alert!

Date: February 10, 2023    Attention: All Providers Effective Date: January 30, 2023 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 […]

Provider Alert! Telemedicine/Telehealth claims guidance

Date: November 30, 2022 Attention: All Providers Effective Date: November 21, 2022 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 […]

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

Date: November 30, 2022 Attention: All providers Effective Date:November 21, 2022 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 […]

Provider Alert! Telemedicine/Telehealth claims guidance

Date: November 21, 2022 Attention: All Providers Effective Date: October 25, 2022 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 […]

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

Date: November 21, 2022 Attention: All providers Effective Date: October 25, 2022    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 […]

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

Date: October 3, 2022 Attention: All providers Effective Date: September 26, 2022 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 […]

Provider Alert! Telemedicine/Telehealth claims guidance

Date: October 3, 2022 Attention: All Providers Effective Date: September 26, 2022 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 […]

Provider Alert! Telehealth Services – PT/OT/ST Providers and COVID-19

Date: September 2, 2021 Attention: All providers. Effective Date: September 7, 2021 Providers should monitor the Texas Children’s Health Plan 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 […]

Provider Alert! Benefits for Telemedicine Services and Telehealth Services to Change for Texas Medicaid December 1, 2020

Attention: FQHCs and  School-based Clinics Effective Date: For dates of service on or after December 1, 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 […]

Provider Alert! Service Planning for Pregnant Women during COVID-19

Attention: OB/GYN Providers Effective Date: June 26, 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. The content in this […]

Provider Alert! COVID-19 Guidance: UPDATE ALERT #5 Telehealth Services: Targeted Case Management through remote delivery

Attention: Behavioral Health, OB/GYN, and ECI Providers Effective Date: April 24, 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 […]

Provider Alert! UPDATE ALERT #3 –Telehealth Services – PT/OT/ST; FQHC/RHC Providers and COVID-19

Attention: All Providers Effective Date: March 31, 2020 Providers should monitor the Texas Children’s Health Plan 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 […]

Provider Alert! Update – Telemedicine & Telehealth Services and COVID-19

Attention: All Providers Effective Date: March 17, 2020 Texas Children’s Health Plan supports the delivery of telemedicine and telehealth services to its members. As part of our COVID-19 Emergency Response, Texas Children’s Health Plan will add coverage of telemedicine services that are provided through only synchronous audio interactions (audio-only telephone consultation). How this impacts providers: […]

Telemedicine support now available

Texas Children’s Health Plan supports the delivery of telemedicine, telehealth and telemonitoring services to its members. Telemedicine and telehealth services should be provided in compliance with standards established by the respective licensing or certifying board of the professional providing the services. Telemedicine and telehealth services do not require authorization when provided by an in-network provider, […]

Telemedicine and Telehealth Webinar

On October 26, 2018, TMHP will host a live webinar to present a high-level overview of Telemedicine and Telehealth services and resources available to providers. Topics covered in the webinar will include: Reimbursements Places of service Provider Types Procedure codes and modifiers Documentation requirements Resources The Telemedicine and Telehealth Services webinar will introduce providers to […]

Telehealth Benefits to Change for Texas Medicaid June 1, 2017

Information posted April 14, 2017 Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, pre-certification, referrals, and claims/encounter data filing may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the client’s specific MCO for details. Effective […]

Provider Alert! Update to Age Requirement for Prior Authorization of Inotuzumab Ozogamicin (Besponsa)

Date: June 6, 2024 Attention: All Providers Effective for dates of service on or after: July 1, 2024 Call to action: The purpose of this communication is to inform providers that effective for dates of service on or after July 1, 2024, the age requirement for prior authorization of inotuzumab ozogamicin (Besponsa) (procedure code J9229) […]

Provider Alert! Implementation of Hormonal Therapy Agents Clinical Prior Authorization

Date: May 28, 2024Attention: All Providers Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that on May 17, 2024 Health and Human Services Commission (HHSC) published an updated Hormonal Therapy Agents Clinical prior authorization criteria guide that was originally implemented on March 1, 2024. Previous TCHP provider alerts on hormonal […]

Provider Alert! Prior Authorization Update for Incontinence Supplies Procedure Code A6250

Date: May 7, 2024 Attention: All Providers Effective: April 10, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers of a prior authorization update for incontinence supplies procedure code A6250, skin sealants, protectants, moisturizers, and ointments, any type, any size. Procedure code A6250 is indicated to treat the following: Incontinence-associated […]

Provider Alert! Change in Preferred Drug List Status for Antihyperuricemics Drug Class

Date: April 25, 2024 Attention: All Providers Effective date: April 22, 2024 Call to action: Effective April 22, 2024, the Texas Health and Human Services (HHS) removed non-preferred status from brand name Mitigare products. This is in response to the discontinuation of the brand products Colcrys by the manufacturer. The preferred status of the brand […]

Provider Alert! New Prior Authorization Resource to Determine Dates of Service

Date: April 3, 2024 Attention: All Providers Call to action: The purpose of this communication is to inform providers of a new resource available from Texas Medicaid and Healthcare Partnership (TMHP) available at https://www.tmhp.com/topics/prior-authorization/pa-calculator.  It is included on the TMHP prior authorization webpage. Providers are encouraged to utilize this calculator to calculate the dates of […]

Provider Alert! Sleep Studies no longer require Prior Authorization

Date: March 22, 2024 Attention: All Providers Effective date: February 7, 2024 Call to action: Effective for dates of service on or after February 7, 2024, Texas Children’s Health Plan (TCHP) will not require a prior authorization for sleep studies. Disclaimer: It is the responsibility of the Provider to verify that a service is a benefit of […]

Provider Alert! Coverage of Elevidys Begins January 2024

Date: February 27, 2024 Attention: All Providers Prior authorization effective date: February 1, 2024 Call to action: The purpose of this communication is to inform providers that on January 1, 2024, Elevidys became a benefit of Medicaid and CHIP. Texas Health and Human Services Commission (HHSC) requires prior authorization for Elevidys (procedure code J1413) for Medicaid […]

Provider Alert! HCPCS and CPT Code Prior authorization Update

Date: February 26, 2024 Attention: All Providers Effective date: January 1, 2024 Call to action: The purpose of this communication is to offer information about the Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) prior authorization updates. Resource: https://www.tmhp.com/sites/default/files/file-library/resources/rate-and-code-updates/hcpcs-updates/2024-hcpcs-special-bulletin.pdf How this impacts providers: Effective January 1, 2024 Texas Children’s Health Plan’s (TCHP’s) […]

Provider Alert! Enzyme Replacement Therapy Prior Authorization Update

Date: February 26, 2024 Attention: All Providers Effective date: February 1, 2024 Call to action: Texas Children’s Health Plan would like to make providers aware of prior authorization updates for certain enzyme replacement therapies. In alignment with Texas Medicaid Provider Procedure Manual (TMPPM) requirements, effective for dates of service on or after February 1, 2024, […]

Provider Alert! Reminder: Prior Authorization Form Completion

Date: February 13, 2024 Attention: All Providers Call to action: Texas Children’s Health Plan (TCHP) supports the guidance from Texas Health and Human Services Commission (HHSC) on rejecting the Prior Authorization (PA) received with incomplete or insufficient documentation per Uniform Managed Care Manual (UMCM), Chapter 3.22. ‘Essential Information’ is the information required to initiate the […]

Provider Alert! Updated Prior Authorization Information for Benlysta (procedure code J0490) and Saphnelo (procedure code J0491)

Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers of prior authorization updates for Belimumab (Benlysta), procedure code J0490, and Anifrolumab-fnia (Saphnelo), procedure code J0491. Effective March 1, 2022, there is no prior authorization requirement for both, and age and diagnosis restrictions are indicated below. Benlysta (J0490) is indicated to treat […]

Provider Alert! UPDATED Coverage of Vyjuvek (procedure code J3401) Begins January 2024; Prior Authorization Effective February 2024

Date: December 6, 2023 Attention: All Providers Prior Authorization Effective Date: February 1, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that on January 1, 2024, Vyjuvek will become a benefit of Medicaid and CHIP. Texas Health and Human Services Commission (HHSC) will require prior authorization for Vyjuvek (procedure […]

Provider Alert! Coverage of Roctavian (procedure code J1412) Begins January 2024; Prior Authorization Effective February 2024

Date: December 6, 2023 Attention: All Providers Prior Authorization Effective Date: February 1, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that on January 1, 2024, Roctavian will become a benefit of Medicaid and CHIP. Texas Health and Human Services Commission (HHSC) will require prior authorization for Roctavian (procedure […]

Provider Alert! Coverage of Adstiladrin (procedure code J9029) Begins January 2024; Prior Authorization Effective February 2024

Date: December 6, 2023 Attention: All Providers Prior Authorization Effective Date: February 1, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective February 1, 2024, Texas Health and Human Services (HHSC) will be implementing prior authorization criteria for Adstiladrin (procedure code J9029). Adstiladrin (nadofaragene firadenovec-vncg) is an […]

Provider Alert! Prior Authorization Signature Requirements

Date: November 20, 2023 Attention: All Providers Effective Date: December 20, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to remind providers that per Texas Medicaid Provider Procedures Manual (TMPPM) Section 5.1, only wet or electronic signatures are accepted for prior authorizations. Prescribing or ordering providers, dispensing providers, clients’ responsible adults, and […]

Provider Alert! Texas Children’s® Link: Efficiently Submit Prior Authorizations

Date: November 6, 2023 Attention: All Providers Call to action: Texas Children’s Health Plan (TCHP) would like to remind providers that they can submit prior authorizations securely online via Texas Children’s® Link, our online provider portal. Providers are encouraged to submit authorization requests on our portal since this is the most efficient way for our […]

Provider Alert! Prior Authorization Requirements will be Changing in January 2024

Date: October 6, 2023 Attention: All Providers Effective date: January 2, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that there will be changes to the prior authorization requirements that become effective on January 2, 2024. Click here to view the requirements. Another resource, Prior Authorization Reference Information, […]

Provider Alert! UPDATE: 2023-24 RSV Season and Synagis Prior Authorization Begins October 2

Date: September 28, 2023 Attention: All Providers Call to action: Vendor Drug Program (VDP) announced the 2023-34 RSV season in a notice published to TexConnect on September 21, 2023. HHSC has since revised Form 1321 to address using the new product, Beyfortus, during the season. UPDATE: Health and Human Services (HHSC) revised the Synagis Standard […]

Provider Alert! 2023-24 RSV Season and Synagis Prior Authorization Begins Oct. 2 For Lower South Texas

Date: September 26, 2023 Attention: All Providers Effective date: October 2, 2023 Call to action: Health and Human Services Commission (HHSC) will begin the 2023-24 Medicaid and CHIP-covered monthly prophylaxis for RSV on October. 2, 2023, for all counties in State Health Service Region 11. We will not open any other regions for Medicaid coverage […]

Provider Alert! Prior Authorization Updates for Neurostimulators and Neuromuscular Stimulators

Date: July 18, 2023 Attention: All Providers Effective date: July 1, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers of a new prior authorization requirement effective July 1, 2023, for neurostimulators and transcutaneous electrical supply- CPT Code A4560. How this impacts providers: This prior authorization requirement aligns with the […]

Provider Alert! Zynteglo® now a Medicaid and CHIP Benefit – Prior Authorization Effective September 1, 2023

Date: July 18, 2023 Attention: All Providers Effective Date: September 1, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective September 1, 2023, the Texas Health and Human Services (HHSC) will be implementing required prior authorization criteria for Zynteglo® (procedure code J3590) for Medicaid and CHIP. Zynteglo® […]

Provider Alert! Signature Updates to Home Health Prior Authorization Request Forms

Date: July 12, 2023 Attention: All Providers Effective date: July 1, 2023 Call to action: The purpose of this communication is to provide awareness that the signature requirements for Title XIX (Medicaid) Home Health Services have changed. Medicaid-enrolled physicians and allowed practitioners can now sign prior authorizations and order covered Medicaid Home Health Services, including […]

Provider Alert! Prior Authorization Diagnosis Coding Reminder

Date: June 20, 2023 Attention: All Providers Call to action: As a reminder, Texas Children’s Health Plan (TCHP) aligns with the Texas Medicaid Provider Procedure Manual (TMPPM) regarding the ICD-10-CM diagnosis-coding requirement on claim submissions. Resource: TMPPM Section 6: Claims filing How this impacts providers: Diagnosis codes guidance as outlined in the TMPPM are as follows: […]

Provider Alert! Subject: Unclassified Medical Drugs Prior Authorization Requirement

Date: May 8, 2023 Attention: All Providers Effective Date: June 8, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective June 8 2023, medical claims under $5,000 submitted to TCHP with unclassified Healthcare Common Procedure Coding System (HCPCS) code J3490 will no longer require a pre-service (prior authorization) request […]

Provider Alert! Lidocaine 5% Patch Added To PDL

Date: April 21, 2023 Attention: All Providers Effective Date: April 3, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective April 3, 2023, the Texas Health and Human Services Commission (HHSC) temporarily removed the non-preferred status from the generic product, Lidocaine 5% patches on the preferred drug list (PDL). […]

Provider Alert! Prior Authorization Criteria Update for Amvuttra

Date: December 29, 2022 Attention: All Providers Effective date: February 1, 2023 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. […]

Provider Alert! Synagis Prior Authorization Guidance – Reminder

Date: December 28, 2022 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. Call to action: Beginning with […]

Provider Alert! COVID-19 Disaster Declaration – ALERT #5 – Prior Authorization Adjustments

Date: November 30, 2022   Attention: All Providers Effective Date: November 21, 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 […]

Provider Alert! Prior Authorization Criteria for Carvykti Begins December 1, 2022

Date: November 28, 2022 Attention: Providers Subject: Effective date: December 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. […]

Provider Alert! COVID-19 Disaster Declaration – ALERT #5 – Prior Authorization Adjustments

Date: November 21, 2022 Attention: All Providers Effective Date: October 25, 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. […]

Provider Alert! CGRP Antagonists- Prophylaxis, Prior Authorization Revision Scheduled for November 22, 2022

Date: November 14, 2022 Attention: Providers Effective Date: November 22, 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 […]

Provider Alerts! Prior Authorization Updates

Date: November 7, 2022 Attention: All Providers               Effective date: September 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. […]

Provider Alert! Clinical Criteria Update for Orkambi Effective November 9

Date: October 25, 2022 Attention: Providers Effective Date: October 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 […]

Provider Alerts! Cosentyx Clinical Prior Authorization Criteria Revision Scheduled for November 22

Date: October 25, 2022 Attention: Providers Effective Date: October 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 […]

Provider Alert! RSV Fall/Winter Traditional Season Regional Changes Begin October 17

Date: October 17, 2022 Attention: All Providers  Effective Date: October 17, 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. […]

Provider Alert! PDL Prior Authorization Criteria Revisions Scheduled for October 11

Date: October 11, 2022 Attention: All Providers Effective Date: October 11, 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. […]

Provider Alert! Clinical Prior Authorization Criteria Revisions Implement for Medicaid Fee-for-Service on October 26

Date: October 5, 2022 Attention: All Providers Subject: Effective Date: October 26, 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 […]

Provider Alert! COVID-19 Disaster Declaration – ALERT #5 – Prior Authorization Adjustments

Date: October 3, 2022 Attention: All Providers Effective Date: September 26, 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. […]

Provider Alert! Drug Regimen Optimization Edit Removed After September 12

Date: September 20, 2022 Attention: All Providers Effective Date: September 12, 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. […]

Provider Alert! Prior Authorization Criteria Update for Adakveo

Date: September 20, 2022 Attention: All Providers Effective Date: December 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. […]

Provider Alert! Prior Authorization Criteria Update for Zolgensma

Date: September 20, 2022 Attention: All Providers Effective Date: November 11, 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. […]

Provider Alert! Prior Authorization Criteria to Change for Some CAR T-Cell Infusion Therapies 

Date: September 13, 2022 Attention: All Providers Effective Date: September 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. […]

Provider Alert! Clinical Prior Authorization for Xenical No Longer Required After September 12, 2022

Date: August 19, 2022 Attention: All Providers Subject: Clinical Prior Authorization for Xenical No Longer Required After September 12, 2022  Effective Date: September 12, 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 […]

Provider Alert! Texas Children’s Link Update – Prior Authorizations

Date: August 5, 2022 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. Call to action: Texas Children’s […]

Provider Alert! Prior Authorization Criteria Update for Breyanzi and Kymriah

Date: July 27, 2022 Attention: All Providers Effective Date: September 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. […]

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 […]

Provider Alert! All MCOs: Dupixent, Evrysdi, and Qelbree Clinical Prior Authorization Criteria Updates

Date: July 13, 2022 Attention: Providers Effective Date: August 2, 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 […]

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 […]

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. […]

Provider Alert! Prior authorization criteria for Voxzogo (Vosoritide)

Date: June 15, 2022 Attention: All Providers Subject: Prior authorization criteria for Voxzogo (Vosoritide) Effective Date: July 15, 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 […]

Provider Alert! Prior Authorization Criteria Update for Aduhelm Begins July 1

Date: June 15, 2022 Attention: All Providers Subject: Prior Authorization Criteria Update for Aduhelm Begins July 1 Effective Date: July 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 […]

Provider Alert! Prior Authorization Criteria Updates for Yescarta and Tecartus

Date: June 1, 2022 Attention: All Providers Effective Date: July 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. […]

Provider Alert! Push-rim Activated Power Assist Wheelchair (PAPAW) System Procedure Code E0986 to Become a Benefit for Texas Medicaid

Date: May 25, 2022 Attention: All Providers Effective Date: June 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. […]

Provider Alert! Laser Interstitial Thermal Therapy to Require Prior Authorization

Date: April 6, 2022   Attention: Radiologists Effective date: July 5, 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. […]

Provider Alert! Updates to Phosphate Binder Prior Authorization Criteria Scheduled for April 5

Date: March 10, 2022 Attention: Primary care providers Effective Date: April 05, 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 […]

Provider Alert! Oxbryta Prior Authorization Criteria Updates Scheduled for April 5

Date: March 10, 2022 Attention: Primary care providers Effective Date: April 5, 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 […]

Provider Alert! Prior Authorization Criteria to Change for Omalizumab (Xolair) Effective March 1, 2022

Date: March 3, 2022 Attention: Primary care providers Effective Date: March 01, 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 […]

Provider Alert! 2022 Healthcare Common Procedure Coding System (HCPCS) Update

Date: February 11, 2022 Attention: All Providers Effective Date: January 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. […]

Provider Alert! New Autism Services Benefit for Medicaid Recipients

Date: January 28, 2022 Attention: Primary Care Providers, Developmental Pediatricians, and Neurologists Effective Date: February 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 […]

Provider Alert! Removal of Specialist Requirement from Clinical Prior Authorization Criteria

Date: January 28, 2022 Attention: Providers Effective Date: January 3, 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 […]

Provider Alert! Prior Authorization Criteria for Enzyme Replacement Therapy

Date: January 28, 2022 Attention: Providers Effective Date: March 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 […]

Provider Alert! Prior Authorization Criteria for Benlysta (J0490)

Date: January 14, 2022 Attention: Oncology Providers Effective Date: March 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. […]

Provider Alert! Prior Authorization Criteria for Saphnelo (C9086)

Date: January 14, 2022 Attention: Oncology Providers Effective Date: March 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. […]

Provider Alert! Prior Authorization Criteria for Aduhelm

Date: December 28, 2021 Attention: All Providers Effective Date: January 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. […]

Provider Alert! Clinical Prior Authorization Criteria Update for Repatha (evolocumab)

Date: December 7, 2021 Attention: Primary Care Providers Effective Date: December 6, 2021 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 […]

Provider Alert! Promethazine Update

Date: December 7, 2021 Attention: Primary Care Providers Effective Date: December 7, 2021 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 […]

Provider Alert! Breyanzi available on Medicaid formulary with prior authorization requirements

Date: October 26, 2021 Attention: Oncologists Effective Date: October 1, 2021 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 […]

Provider Alert! Alinia (Nitazoxanide) Formulary Change

Date: October 18, 2021 Attention: All Providers Effective date: November 23, 2021 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. […]

Provider Alert! Fetal Magnetic Resonance Imaging (MRI) Requires Prior Authorization

Date: October 11, 2021 Attention: All Providers Effective Dates: June 1, 2021 for code 74712 and April 1, 2021 for code 74713 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 […]

Provider Alert! Vision Services-Nonsurgical Benefits to Change

Date: August 25, 2021 Attention: Optometrists and Ophthalmologists Effective Date: September 1, 2021 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 […]

Provider Alert! Sleep Study Prior Authorization Update

Date: August 19, 2021 Attention: Primary Care Providers , Neurologists Effective Date: December 1, 2021 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 […]

Provider Alert! Therapy Prior Authorization Update

Date: July 29, 2021 Attention: All Providers Effective Date: August 1, 2021 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. […]

Provider Alert! Prior authorization Updates   

Date: July 23, 2021 Attention: All Providers Effective Dates: August 1, 2021 and November 1, 2021 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 […]

Provider Alert! Trikafta Age Expansion in Cystic Fibrosis Agents Clinical Prior Authorization Begins September 1

Date: July 8, 2021 Attention: Primary Care Providers and Pulmonologists Effective Date: September 1, 2021 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 […]

Provider Alert! Speech, Physical, and Occupational Therapy Prior Authorization Update

Date: June 23, 2021 Attention: Therapy and Primary Care Providers Effective Date: June 23, 2021 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 […]

Provider Alert! Reminder: Targeted Case Management Code T1017 Requires Prior Authorization

Date: June 22, 2021 Attention: Primary Care Providers and Behavioral Health 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. […]

Provider Alert! Clinical Prior Authorization Updates for Enzymes

Date: May 20, 2021 Attention: Geneticists, Hematologists, and Oncologists Effective Date: June 30, 2021 Call to action: Effective June 30, 2021, the Texas Health and Human Services Commission (HHSC) will update the enzymes prior authorization criteria to reflect recent FDA-approved administration changes. This impacts the following agents: Adagen (pegademase bovine), Ceprotin (protein C concentrate), Fabrazyme […]

Provider Alert! Peer to Peer Provider Authorization Communication

Date: April 23, 2021 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. Call to action: Texas Children’s […]

Provider Alert! Prior Authorization Update for Continuous Glucose Monitoring

Date: April 20, 2021 Attention: All Providers Effective Date: April 20, 2021 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. […]

Provider Alert! Online Authorization Platform is Able to Accept Additional Clinical Information 

Date: April 8, 2021 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. Call to action: Texas Children’s […]

Provider Alert! Reminders: Prior Authorization Requirements and Qualifications for Urgent Requests

Date: May 5, 2021 Attention: All Providers Reminders: Prior Authorization Requirements and Qualifications for Urgent Requests 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 […]

Provider Alert! Prior Authorization Criteria for Zolgensma Updated

Date: April 22, 2021 Attention: Neurologists and SMA specialists Effective Date: May 1, 2021 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 […]

Provider Alert! Genetic Testing Prior Authorization Requirement Reminder

Date: March 26, 2021 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. Call to action: Texas Children’s […]

Provider Alert! Clinical Prior Authorization Updates for Epidiolex

Date: March 26, 2021 Attention: Neurologists Effective Date: May 11, 2021 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 […]

Provider Alert! Clinical Prior Authorization Updates for Cytokine and CAM Antagonist Agents

Date: March 25, 2021 Attention: Gastroenterologists, Rheumatologists Effective Date: May 4, 2021 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.  […]

Provider Alert! Prior Authorization Requirements for Incontinence Supplies

Date: March 15, 2021 Attention: All Providers Effective Date: December 22, 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.  […]

Provider Alert! Healthcare Common Procedure Coding System (HCPCS) update for Code 99201

Date: January 21, 2021 Attention: All Providers Effective Date: January 1, 2021 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. […]

Provider Alert! Clinical Prior Authorization Updates for Cystic Fibrosis Agents

Date: February 25, 2021 Attention: Pulmonologists Effective Date: April 6, 2021 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 […]

Provider Alert! Viltepso Prior Authorization Update

Date: February 19, 2021 Attention: Neurologists Effective Date: March 1, 2021 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 […]

Provider Alert! Changes to Hepatitis C Drug Coverage and Prior Authorization

Date: February 16, 2021 Attention: Gastroenterologists and Hepatologists Effective Date: March 1, 2021 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 […]

Provider Alert! Macrolides Clinical Prior Authorization Update

Date: February 19, 2021 Attention: Primary Care Providers Effective Date: March 15, 2021 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 […]

Provider Alert! Subject: Prior Authorization Guideline updates for Private Duty Nursing (PDN)

Attention: All Providers Effective Date: March 1, 2021 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: TCHP […]

Provider Alert! Oseni and the Thiazolidinediones (TZD) Clinical Prior Authorization Update

Date: January 26, 2021 Attention: Primary Care Providers and Endocrinologists  Effective Date: February 4, 2021 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 […]

Provider Alert! Injectable and Oral Desmopressin Clinical Prior Authorization Update

Date: January 26, 2021 Attention: PCPs, Endocrinologists, and Hematologists Effective Date: March 15, 2021 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 […]

Provider Alert! Prior Authorization Criteria for Tecartus Updated January 1, 2021

Date: January 26, 2021 Attention: Oncologists Effective Date: January 1, 2021 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 […]

Provider Alert! Prior Authorization Criteria for Uplizna

Date: January 19, 2021 Attention: All Providers Effective Date: January 1, 2021 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. […]

Provider Alert! Evrsydi available on Medicaid formulary with prior authorization requirements on Feb 1

Date: January 25, 2021 Attention: Neurologists and SMA specialists Effective Date: February 1, 2021 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 […]

Provider Alert! Essential Information for Prior Authorization Submission

Date: January 13, 2021 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. Call to action: Texas Children’s […]

Provider Alert! Prior Authorization Re-certification Requests Submission for Texas Medicaid

Date: January 7, 2021 Attention: Therapy Providers Effective Date: October 1, 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. […]

Provider Alert! New prior authorization requirements for Mepolizumab (Nucala)

Date: December 21, 2020 Attention: Allergists & Immunologists, Pulmonologists Effective Date:  February 1, 2021 Call to action: Texas Children’s Health Plan (TCHP) is aligning prior authorization criteria for mepolizumab (Nucala), J2182, with the Texas Medicaid Provider Procedures Manual (TMPPM). Mepolizumab (Nucala) is a clinician administered drug indicated for members with severe asthma with an eospinophilic […]

Provider Alert! Prior Authorization Requirements Guide

Attention: All Providers Effective Date: March 8, 2021 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 […]

Provider Alert! Reminder of Therapy Benefits and Services Requiring a Prior Authorization

Attention: Primary Care, Therapy Providers, and Sub-specialties 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 […]

Provider Alert! Benefit reminder and Prior Authorization Update for Spravato

Attention: Behavioral health Providers Effective Date: January 1, 2021 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: […]

Provider Alert! Updates to Prior Authorization Requirements for Genetic Testing, Wheelchair accessory, and Personal Care Services

Attention: All providers Effective Date: March 1, 2021 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 […]

Provider Alert! Updates to Prior Authorization Requirements for CADs, electronic bone growth stimulators, home telemonitoring, and hospital beds

Attention: All providers Effective Date: February 1, 2021 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 […]

Provider Alert! Prior Authorization Guideline updates for TMJ and Skilled Nursing Facility

Attention: All Providers Effective Date: August 25, 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: Texas […]

Provider Alert! New prior authorization requirements for Teprotumumab-trbw (Tepezza)

Attention: Ophthalmologists and Endocrinologists Effective Date: January 19, 2021 Call to action: Texas Children’s Health Plan (TCHP) is aligning prior authorization criteria for teprotumumab-trbw (Tepezza), J3241 (formerly procedure code C9061), with the Texas Medicaid Provider Procedures Manual (TMPPM). Tepezza is a clinician administered drug indicated for members with thyroid eye disease (TED). Below are the […]

Provider Alert! Prior Authorization Update for Botulinum Toxin Benefits with Diagnosis Restriction

  Date: May 20, 2021 Attention: All Providers   Effective Date: May 18, 2021 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 […]

Provider Alert! Prior Authorization Update for HCPCS Code H2011, Crisis Intervention

Attention: Behavioral Health Providers Effective Date: September 22, 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: […]

Provider Alert! Prior Authorization Guideline updates for Private Duty Nursing (PDN) and therapy specialty services

Attention: All Providers Effective Date: July 18, 2020 for PDN and August 11, 2020 for therapy Services 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 […]

Provider Alert! Generic Albuterol Products Return to Non-Preferred Status for Medicaid Members

Attention: All Providers Effective Date: August 28, 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: Beginning […]

Provider Alert! Medicaid drug formulary changes

Attention: All Providers Effective Date: July 31, 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: The Texas Vendor […]

Provider Alert! Adakveo Update

Attention: Hematologists Effective Date: July 1, 2020 Call to action: Texas Children’s Health Plan (TCHP) aligns with the prior authorization criteria available in the most recent Texas Medicaid Provider Procedures Manual (TMPPM), Clinician Administered Drugs Handbook. Prior authorization guidelines began May 26, 2020. Adakveo, Injection, crizanlizumab – clinician administered drug HCPCS code C9053 is being replaced with […]

Provider Alert! Age Limitation Change for Antisense Oligonucleotides Benefits

Attention: Neurologists Effective Date: For dates of service on or after January 1, 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 […]

Provider Alert! Prosthetics Codes Prior Authorization Requirements

Attention: Prosthetics, DME providers, orthopedists, podiatrists, PCPs Effective Date: June 3, 2020 Call to action: Texas Children’s Health Plan (TCHP) aligns with Texas Medicaid Provider Procedures Manual (TMPPM) and requires prior authorization for prosthetics procedures codes. How this impacts providers: Provider offices should utilize the Standard Prior Authorization Form for prosthetics. References: TCHP Prior Authorization Requirements […]

Provider Alert! Prior Authorization guidelines for Manual Wheelchair Accessory Code E2227

Attention: All Providers Effective Date: June 23, 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: Texas […]

Provider Alert! Update: Prior Authorization Criteria for Brexanolone (Zulresso)

Attention: : Behavioral Health and Obstetric care providers Effective Date:  July 1, 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 […]

Provider Alert! Authorization update for orthoses devices and related services

Attention: DME providers, orthopedists, podiatrists, PCPs Effective Date: September 5, 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 […]

Provider Alert! Update: Updates to Prior Authorization Requirements

Attention: All 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: TCHP would […]

Provider Alert! Adakveo Update

Attention: Hematologists Effective Date: May 26, 2020 Call to action: Adakveo, Injection, crizanlizumab – clinician administered drug HCPCS code C9053 is an at risk drug. Currently, there is no prior authorization required; however, beginning May 26, 2020 authorization guidelines will be in place. The required criteria to receive Adakveo include: HbSS (sickle cell) diagnosis Patients over the age of […]

Provider Alert! Secretion and Mucous Clearance Device Update on rental option

Date: December 17, 2021 Attention: Pulmonologists and DME providers Effective Date: June 1, 2020 for Intrapulmonary Percussive Ventilation (IPV) rental information Call to action: update for December 17, 2021: Intrapulmonary Percussive Ventilation (IPV)*: effective June 1, 2020, this device is available for rent only and no longer has the rent to purchase option. Secretion and […]

Provider Alert! COVID-19 Disaster Declaration – ALERT #3 – Prior Authorization Adjustments

Attention: All Providers Effective Date: April 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: […]

Provider Alert! Patient Lifts

Attention: Primary Care and DME Providers Effective Date: July 3, 2020 Call to action: In accordance with Texas Medicaid Provider Procedure Manual (TMPPM), patient lifts will require prior authorization, except for E0637 & E0641when billed outside of the benefit limitations.  Click here for the Prior Authorization Form. Coding information for lifts as an addition to the […]

Provider Alert! COVID-19 Disaster Declaration – ALERT #2 – Prior Authorization Adjustments

Attention: All Providers Effective Date: April 1, 2020 Providers should monitor the Texas Children’s Health Plan 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: As are […]

Provider Alert! COVID-19 Disaster Declaration – Prior Authorization Adjustments

Attention: All Providers Effective Date: March 18, 2020 TCHP affiliated providers should monitor the 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: As are […]

Provider Alert! Updated: Non-Emergency Ambulance Guideline

Date: February 25, 2020 Attention: All providers Updates include the following change: for approved requests, TCHP will include one unscheduled trip (if not already requested) per month to the authorization request to allow access to transport for unscheduled trips. Reminders: Texas Children’s Health Plan does not accept authorization requests from ambulance/medical transportation vendors for non-emergency […]

Provider Alert! Medicaid drug formulary changes effective 1/30/2020

The Texas Vendor Drug Program (VDP) will implement changes to the state Medicaid drug formulary, effective Thursday, January 30, 2020. Select medications will be moving from “preferred” to “non-preferred” status and vice-versa. Texas Children’s Health Plan wanted to notify you in advance so that these changes do not impact the ability of your patients to [...]

Provider Alert! Update: Prior Authorization Requirements

Please note the following key prior authorization requirement changes for providers. Updates: Effective July 1, 2019 Psychological testing (procedure codes 96130, 96131, 96136, and 96137), neurobehavioral testing (procedure codes 96116 and 96121), and neuropsychological testing (procedure codes 96132, 96133, 96136, and 96137) are limited to four hours per member, per day and eight hours per […]

Provider Alert! TCHP Prior Authorization Requirements

Date:  July 1, 2019 Subject: TCHP Prior Authorization Requirements Effective October 1, 2019, TCHP has updated the prior authorization listing. Please note there are some key changes for providers.   Added:            Case by Case Added Services This category includes CPT/HCPCS codes that are listed as not payable in the TMHP […]

Prior Authorization Reference Information

The Texas Children’s Health Plan website now has an additional resource for information related to prior authorization requirements. The Prior Authorization Reference Information documents the codes that require authorization for payment based on authorization category. This list is not yet all-inclusive. It can be found at: https://www.texaschildrenshealthplan.org/sites/default/files/pdf/PA%20Code%20List%20December%202018.pdf In addition, providers can submit an authorization request […]

Prior Authorization Reference Information

The Texas Children’s Health Plan website now has an additional resource for information related to prior authorization requirements. The Prior Authorization Reference Information documents the codes that require authorization for payment based on authorization category. This list is not yet all-inclusive. It can be found at: https://www.texaschildrenshealthplan.org/sites/default/files/pdf/PA%20Code%20List%20December%202018.pdf In addition, providers can submit an authorization request […]

Provider Alert! Prior Authorization

Prior authorization alert Effective January 1, 2019, Texas Children’s Health Plan updated the prior authorization listing. Please note there are some key changes for providers. Removed from the list and will no longer require prior authorization: Baclofen Pump New to the list: Home Telemonitoring Updates: Ambulance (non-emergent transport) has been updated to Non-Emergency Ambulance Transport. […]

Provider Alert! Prior Authorization Alert

Effective January 1, 2019, Texas Children’s Health Plan updated the prior authorization listing. Please note there are some key changes for providers. Removed from the list and will no longer require prior authorization: Baclofen Pump New to the list: Home Telemonitoring Updates: Ambulance (non-emergent transport) has been updated to Non-Emergency Ambulance Transport. Augmentative Communication Device […]

Provider Alert! TCHP Prior Authorization Requirement

Effective January 1, 2019, TCHP will be updating the prior authorization listing. Please note there are some key changes for providers. Removed from the list and will no longer require prior authorization: Baclofen Pump New to the list: Home Telemonitoring Updates: Ambulance (non-emergent transport) has been updated to Non-Emergency Ambulance Transport. Augmentative Communication Device has […]

Nutritional supplement guideline change

Effective 10/1/2018, Texas Children’s Health Plan will no longer require prior authorization for nutritional products for members 20 years and younger who: receive all or part of their nutritional intake through a tube as documented by ICD-10 codes (z43.1; z93.1, z93.4), OR have a metabolic disorder that has been documented with one of the diagnosis […]

Provider Alert! Nutritional Supplement Guideline Change

Effective 10/1/2018, Texas Children’s Health Plan will no longer require prior authorization for nutritional products for members 20 years and younger who: receive all or part of their nutritional intake through a tube as documented by ICD-10 codes (z43.1; z93.1, z93.4), OR have a metabolic disorder that has been documented with one of the diagnosis […]

Key Changes to TCHP Therapy Authorization Guidelines

When services were not prior authorized by Texas Children’s Health Plan, (through another MCO or TMHP) the authorization request must include: A copy of the previously approved authorization letter. All of the documentation that was sent in the original authorization request to the previous MCO or TMHP, including any physician orders that were used to […]

Upcoming Changes to Prior Authorization for Antipsychotic Medications

Effective September 1, 2018, the prior authorization for antipsychotic medications will change. At the May 15th Texas Association of Community Health Plans P&T Committee meeting, the Texas Managed Care Organizations, supported by Navitus, voted by majority to modify the Antipsychotic Clinical Prior Authorization Edit in compliance with the guidelines set forth by the Health and […]

Provider Alert! Reminder: Authorization Requirements and Code Configuration

As a reminder, Texas Children’s Health Plan continues to require authorization for the following service categories: Bariatric surgery Circumcision in children 1 year of age and older General anesthesia for dental procedures for children 6 years and under (STAR and STAR Kids only) Oral surgery and medically necessary dental procedures Therapeutic and reconstructive breast procedures [...]

Texas Standard Prior Authorization Form

Texas Children’s Health Plan prefers the submission of the Texas Standard Prior Authorization form for prior authorization requests, excluding LTSS services. Requests should also include supporting clinical documentation as per the Texas Children’s Health Plan Authorization Guidelines. The form is available on the Texas Children’s Health Plan website at http://www.texaschildrenshealthplan.org/for-providers/resources/downloadable-forms.

Provider Alert! TCHP Prior Authorization Requirement

Subject: TCHP Prior Authorization Requirement Effective April 1, 2018, TCHP will be updating the prior authorization listing. This notice will serve as your 90-day advance notification of the change. Please note there are some key changes for providers. Removed from the list and will no longer require prior authorization: Walkers Vision Care, medically necessary New […]

Reminder on obtaining an authorization for genetic testing

Quest Diagnostics is the exclusive contracted lab for TCHP. For OB providers, all genetic testing requires prior authorization. Link to all services that require prior authorization: http://www.texaschildrenshealthplan.org/sites/default/files/pdf/Pre-Certification%20Requirements%20JULY%202017.pdf

Provider Alert! Changes to physical, occupational and speech therapy benefits for all ages

Effective for dates of service on or after September 1, 2017, physical therapy (PT), occupational therapy (OT) and speech therapy (ST) benefits for all ages will change for Texas Medicaid. Please visit the TMHP website to review for changes to this medical benefit policy that applies to the following: Billing structure changes for PT, OT […]

Provider Alert! Prior Authorization of Texas Health Steps (THSteps) dental therapy under general anesthesia for members who are six years of age or younger

Effective July 1, 2017, Texas Children’s Health Plan will be required to implement prior authorization for Level 4 deep sedation and general anesthesia provided in conjunction with therapeutic dental treatment for Medicaid dental clients from ages 0 through six years. All Level 4 services must be authorized prior to rendering services. Anesthesia services provided by a […]

Provider Alert! Benefit Changes Prior Authorization Update

Attention: All Texas Children’s Health Plan Providers Subject: UPDATE to Changes for Physical, Occupational, and Speech Therapy Benefits   Prior Authorization Changes Update Changes to TCHP Prior Authorizations for PT, OT, and ST services: For therapy authorizations with approved dates of service spanning the 9/1 transition date, TCHP created a revised authorization in our system […]

NEW fax number to expedite prior authorization for STAR Kids outpatient private nursing

Effective May 22, 2017, providers should fax prior authorization forms to 346-232-4757. The form can be found at http://www.texaschildrenshealthplan.org/for-providers/resources/downloadable-forms

Helping patients access and adhere to antipsychotic medications

A common reason for behavioral health readmission is delay to an outpatient supply of antipsychotic medications. You can help avoid this problem by completing prior authorization documentation before a patient is discharged. Texas Children’s Health Plan follows Texas Medicaid Guidelines for the use and approval of antipsychotics in children. Prior authorization documentation for antipsychotic medications […]

Provider Alert! Changes to Physical, Occupational, and Speech Therapy Benefits for All Ages

Effective for dates of service on or after September 1, 2017, physical therapy (PT), occupational therapy (OT), and speech therapy (ST) benefits for all ages will change for Texas Medicaid. Please review this link for changes to this medical benefit policy that applies to the following: Billing structure changes for PT, OT, and ST services […]

Provider Alert! STAR Kids Prescription/Pharmacy Prior Authorizations Reinstated 4/15/17

PRESCRIPTION PRIOR AUTHORIZATION NOTIFICATION Subject: STAR Kids Prescription/Pharmacy Prior Authorizations Reinstated 4/15/17 Effective 4/15/17, Texas Children’s Health Plan (TCHP) will enforce pharmacy prior authorization (PA) requirements for STAR Kids members STAR Kids members who received a prescription between 11/1/16-4/15/17 were not subject to normal PA requirements. PA requirements were temporarily lifted during this period to […]

Attention: Star Kids Providers: Prior Authorization required on all Vendor Drug Program (VDP) identified medications

Texas Children’s Health Plan requires prior authorization (PA) on all medications on the VDP website prior to dispensing to members. To obtain a list of medications requiring prior authorization, visit the VDP website at: http://www.txvendordrug.com/formulary/preferred-drugs.shtml Providers can also view instructions on accessing and using the formulary at the Texas Children’s Health Plan website: http://www.thecheckup.org/2016/06/09/do-you-know-how-to-access-the-texas-childrens-health-plan-formulary/ Providers […]

Provider Alert! Prior Authorization required on all Vendor Drug Program (VDP) identified medications

Attention: Star Kids Providers Subject: Reminder: Prior Authorization required on all Vendor Drug Program (VDP) identified medications Texas Children’s Health Plan requires prior authorization (PA) on certain medications per the VDP website prior to dispensing to members. To obtain a list of medications requiring prior authorization, visit the VDP website at: http://www.txvendordrug.com/formulary/preferred-drugs.shtml Providers can also […]

Provider Alert! All Texas Children’s Health Plan providers and facilities Utilization Management Guidelines effective November 1, 2016

Texas Children’s Health Plan has developed Utilization Management guidelines that serve as criteria for the determination of medical necessity for services that require prior authorization. These guidelines will be effective on November 1, 2016. The goal of Texas Children’s Health Plan’s Utilization Management guidelines is to encourage the highest quality care from the right provider […]

Provider Alert! Addition of Paxlovid (Pfizer Oral Covid-19 Drug) to Formulary

Date: January 8, 2024 Attention: Providers Effective date: January 4, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective January 4, 2024, the Texas Health and Human Services (HHS) added Paxlovid to the formulary. Paxlovid (nirmatrelvir co-packaged with ritonavir) is an oral antiviral tablet, is indicated for […]

Provider Alert! Coverage of Commercialized COVID-19 Vaccines Begins as a Pharmacy Benefit

Effective Dates: As of September 11, 2023 & October 3, 2023 Date: December 4, 2023 Attention: All Providers Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective for dates of service on or after September 11, 2023 and October 3, 2023, the U.S. Food and Drug Administration’s (FDA) issued […]

Provider Alert! COVID-19 Vaccine Procedure Code 91304

Date: November 27, 2023 Attention: All Providers Effective for dates of service on or after October 3, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective for dates of service on or after October 3, 2023, in accordance with the U.S. Food and Drug Administration’s (FDA) amended emergency […]

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 […]

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) […]

Provider Alert! UPDATED: COVID-19 Vaccine Counseling Procedure Code G0315 Now a Benefit

Date: August 7, 2023 Attention: All Providers Effective date: Dates of service on or after December 2, 2021 Call to action: Texas Children Health Plan (TCHP) would like to inform providers that effective for dates of service on or after December 2, 2021, COVID-19 vaccine counseling procedure code G0315 is a benefit of Medicaid for […]

Provider Alert! Reimbursement for COVID-19 Vaccines for FQHCs and RHCs Reminder

Date: July 13, 2023 Attention: FQHC and RHC Providers End date for vaccine procedure codes: May 12, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to remind FQHC and RHC providers of the guidance from Texas Medicaid and Healthcare Partnership (TMHP) on COVID-19 vaccine procedure codes. Effective for dates of service on […]

Provider Alert! COVID-19 Vaccine Administration Procedure Code 0174A Is Now a Benefit of Medicaid and CHIP

Date: May 16, 2023 Attention: All Providers Effective date: Dates of service on or after March 14, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective for dates of service on or after March 14, 2023, in accordance with the U.S. Food and Drug Administration’s amended Emergency Use […]

Provider Alert! Infection Control Supplies Procedure Code S8301 No Longer a Benefit

Date: May 16, 2023 Attention: All Providers Effective Date: May 12, 2023 Call to action: Texas Children Health Plan (TCHP) would like to inform providers that effective with the end of the federal public health emergency (PHE) on May 11, 2023, the Health and Human Services Commission (HHSC) will end multiple temporary flexibilities related to […]

Provider Alert! End of COVID flexibilities: Provider Signatures for All Therapy Services and Hearing Screening for Speech Therapy

Date: May 15, 2023 Attention: All Providers Effective date: June 13, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to make providers aware of the end to some COVID flexibilities related to Utilization Management.  Background information: The Health and Human Services Commission (HHSC) received notice that the COVID-19 federal public health emergency […]

Provider Alert! HHSC to End Telephone (Audio-only) Medical Services COVID-19 Guidance and Issue Temporary Guidance for Certain Audio-Only Services

Date: May 8, 2023 Attention: All Providers Effective date: May 12, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective May 11, 2023, Health and Human Services Commission (HHSC) will end the temporary flexibility that has been allowed for telephone (audio-only) medical (physician-delivered) E/M services. HHSC authorized providers […]

Provider Alert! Monovalent Moderna and Pfizer-BioNTech COVID-19 Vaccines Removed From Formulary on April 21, 2023

Date: May 8, 2023 Attention: All Providers Effective Date: April 21, 2023 Call to action: Texas Children Health Plan (TCHP) would like to inform providers that effective April 21, 2023, the U.S. Food and Drug Administration (FDA) amended the emergency use authorizations of the Moderna and Pfizer-BioNTech COVID-19 bivalent mRNA vaccines. This is to simplify the […]

Provider Alert! COVID-19 Vaccine Counseling Procedure Code G0315 Now a Benefit

Date: April 14, 2023 Attention: All Providers Effective Date: Dates of service on or after December 2, 2021 Call to action: Texas Children Health Plan (TCHP) would like to inform providers that effective for dates of service on or after December 2, 2021, COVID-19 vaccine counseling procedure code G0315 is a benefit of Medicaid for […]

Provider Alert! Provider Enrollment Revalidation Extensions to End on May 11, 2023

Date: March 21, 2023 Attention: All Providers Call to action: Effective May 11, 2023, the Health and Human Services Commission (HHSC) will end the flexibility of extended Medicaid provider revalidation dates that came due during the COVID-19 public health emergency (PHE). How this impacts providers: Per federal guidance, providers that were due for revalidation effective […]

Provider Alert! HHSC Policy Flexibility for Member State Fair Hearings ends on May 11, 2023

Date: March 21, 2023 Attention: All Providers Call to action: The Health and Human Services Commission (HHSC) is ending the additional 30 days a member has to request a fair hearing starting May 12, 2023. For services provided up until May 11, 2023, Texas Children’s Health Plan (TCHP) will allow the additional 30 days. For […]

Provider Alert! Federal Public Health Emergency Set to End May 11, 2023 – Update on COVID Flexibilities

Date: March 21, 2023 Attention: All Providers Call to action:  The Health and Human Services Commission (HHSC) has received notice that the COVID-19 federal public health emergency (PHE) declared January 31, 2020, will end on May 11, 2023. In response to the PHE, HHSC implemented certain flexibilities for Texas Children’s Health Plan and other managed […]

Provider Alert! Reinstatement of CHIP Co-pays for Medical Office Visits

Date: March 20, 2023 Attention: All Providers Effective Date: May 12, 2023 Call to action: In response to the COVID-19 public health emergency (PHE), the Health and Human Services Commission (HHSC) waived co-pays for Children’s Health Insurance Program (CHIP) medical office visits beginning March 13, 2020. HHSC will reinstate co-pays for CHIP medical office visits […]

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 […]

Provider Alert! Telemedicine/Telehealth claims guidance Provider Alert!

Date: February 10, 2023    Attention: All Providers Effective Date: January 30, 2023 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 […]

Provider Alert! Provider Alert! Guidance on Appeals and Fair Hearing Requests due to COVID-19

Date: February 10, 2023 Attention: All providers Effective Date: January 30, 2023 The content in this message will remain in effect through April 30, 2023 as announced by the Health and Human Services Commission (HHSC). 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 […]

Provider Alert! COVID-19 Vaccine Administration Procedure Codes 0164A and 0173A are Now Benefits of Medicaid and CHIP

Date: February 10, 2023  Attention: All Providers Effective date: Dates of service on or after December 8, 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 […]

Provider Alert! Health Plan Staff Will Return to Conducting In-home Visits with Members

Date: February 6, 2023 Attention: All Providers Launch date: February 1, 2023 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 […]

Provider Alert! Update to Texas Medicaid and CHIP Coverage for Monoclonal Antibody Therapy Procedure Code Q0222 for the Treatment of COVID-19

Date: February 2, 2023 Attention: All Providers Effective date: August 15, 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 […]

Case Management for Children and Pregnant Women (CPW) COVID-19 Flexibilities

Date: February 1, 2023 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. Call to action: Texas Children’s […]

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

Date: January 30, 2023       Attention: All Providers Effective Date: January 30, 2023 The content in this message will remain in effect through April 30, 2023 as announced by the Health and Human Services Commission. 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 […]

Younger Age Groups Now Eligible For Bivalent COVID-19 Booster Vaccines

Date: January 13, 2023 Attention: All Providers Effective date: December 8, 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. […]

Provider Alert! Genabio COVID-19 At-Home Test Kit Added to Formulary

Date: December 21, 2022 Attention: All Providers Effective date: November 21, 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. […]

Provider Alert! Date: Guidance on Appeals and Fair Hearing Requests due to COVID-19

Date: November 30, 2022 Attention: All providers Effective Date: November 21, 2022 The content in this message will remain in effect through January 31, 2023 as announced by the Health and Human Services Commission (HHSC). 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 […]

Provider Alert! COVID-19 Disaster Declaration – ALERT #5 – Prior Authorization Adjustments

Date: November 30, 2022   Attention: All Providers Effective Date: November 21, 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 […]

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

Date: November 30, 2022              Attention: All Providers Effective Date: November 21, 2022 The content in this message will remain in effect through January 31, 2023 as announced by the Health and Human Services Commission. 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 […]

Provider Alert! COVID-19 Vaccine Administration Procedure Codes 0144A and 0154A Are Now Benefits; Age Range Updated for Procedure Code 0134A

Date: November 10, 2022 Attention: All Providers Effective date: October 12, 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. […]

Provider Alert! COVID-19 Disaster Declaration – ALERT #5 – Prior Authorization Adjustments

Date: November 21, 2022 Attention: All Providers Effective Date: October 25, 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. […]

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

Date: November 21, 2022 Attention: All providers Effective Date: October 25, 2022    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 […]

Provider Alert! Guidance on Appeals and Fair Hearing Requests due to COVID-19

Date: November 21, 2022 Attention: All providers Subject: Effective Date: October 25, 2022 The content in this message will remain in effect through November 30, 2022 as announced by the Health and Human Services Commission (HHSC). 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 […]

Provider Alert! COVID-19 Vaccine Administration Procedure Code 0044A is Now a Benefit of Medicaid and CHIP

Date: November 11, 2022 Attention: All Providers Effective date: Dates of service on or after October 19, 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 […]

Provider Alert! Younger Age Groups Now Eligible For Bivalent COVID-19 Booster Vaccines

Date: November 10, 2022 Attention: All Providers               Effective date: October 12, 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. […]

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

Date: October 26, 2022      Attention: All Providers Effective Date: October 25, 2022  The content in this message will remain in effect through November 30, 2022 as announced by the Health and Human Services Commission. 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 […]

Provider Alert! COVID-19 Procedure Code Updates for Second Quarter 2022 HCPCS

Date: October 12, 2022 Attention: All Providers Effective Date: June 23, 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. […]

Provider Alert! Bivalent Pfizer COVID-19 Booster Vaccine Coverage Update

Date: October 12, 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. […]

Provider Alert! COVID-19 Vaccine Administration Procedure Codes 0124A & 0134A Are Now Benefits for Medicaid & CHIP

Date: October 12, 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. […]

Provider Alert! COVID-19 Disaster Declaration – ALERT #5 – Prior Authorization Adjustments

Date: October 3, 2022 Attention: All Providers Effective Date: September 26, 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. […]

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

Date: October 3, 2022 Attention: All providers Effective Date: September 26, 2022 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 […]

Provider Alert! Guidance on Appeals and Fair Hearing Requests due to COVID-19

Date: October 3, 2022 Attention: All providers Effective Date: September 26, 2022 The content in this message will remain in effect through October 31, 2022 as announced by the Health and Human Services Commission (HHSC). 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 […]

Provider Alert! COVID-19 Vaccine Administration Procedure Codes Age Range Has Changed to 12 Years of Age or Older

Date: October 3, 2022 Attention: All Providers Effective date: August 19, 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. […]

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

Date: September 29, 2022 Attention: All Providers Effective Date: September 26, 2022 The content in this message will remain in effect through October 31, 2022 as announced by the Health and Human Services Commission. 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 […]

Provider Alert! COVID-19 Vaccine Administration Procedure Codes 0041A and 0042A Are Now Benefits for Medicaid/CHIP

Date: August 17, 2022  Attention: All Providers Effective Date: July 13, 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 […]

Provider Alert! COVID-19 Vaccine Administration Procedure Codes 0081A, 0082A, 0083A, 0111A, 0112A, and 0113A Are Now Benefits of Texas Medicaid and CHIP

Date: August 8, 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 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 […]

Provider Alert! COVID-19 Vaccine Administration Procedure Codes 0091A, 0092A, and 0093A Are Now Benefits for Medicaid and CHIP

Date: August 8, 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 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 […]

Provider Alert! Moderna COVID-19 Vaccine Administration Procedure Codes 0011A, 0012A, and 0013A Age Expansion for Medicaid and CHIP

Date: August 5, 2022 Attention: All Providers Effective Dates: June 17, 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 […]

Provider Alert! Novavax COVID-19 Vaccine Coverage Update

Date: July 29, 2022 Attention: All Providers Effective date: July 13, 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. […]

Provider Alert! COVID-19 Vaccine Administration Procedure Codes 0074A and 0094A Are Now a Benefit of Medicaid and CHIP

Date: July 8, 2022 Attention: All Providers Effective Dates:  Procedure Code 0094A on or after March 29, 2022 Procedure Code 0074A on or after May 17, 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 […]

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. […]

Provider Alert! : COVID-19 Drug Veklury (Remdesivir) Update

Date: July 5, 2022 Attention: All Providers Effective Date: April 25, 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. […]

Provider Alert! Monoclonal Antibody Procedure Code Q0221 for Treatment of COVID-19 Added to Texas Medicaid Benefits

Date: July 5, 2022 Attention: All Providers   Effective Date: February 24, 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 […]

Provider Alert! Procedure Codes M0222, M0223 & Q0222 for COVID-19 Treatments Added as Texas Medicaid & CHIP Benefits

Date: July 5, 2022 Attention: All Providers Effective Date: February 11, 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. […]

Provider Alert! COVID-19 Convalescent Plasma Benefit Modified

Date: July 5, 2022 Attention: All Providers Effective Date: December 28, 2021 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. […]

Provider Alert! Mental Health and Substance Use Disorder Outpatient & Residential Services Co-Payments Prohibited

Date: June 29, 2022 Attention: Behavioral Health Providers Effective date: July 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 […]

Provider Alert! COVID-19 Guidance for FMSAs and CDS Employer Orientations

Date: June 27, 2022 Attention: FMSA providers Effective Date: June 23, 2022 The content in this message will remain in effect through August 31, 2022, as announced by the Health and Human Services Commission. Effective February 1, 2022, FMSAs can permanently conduct new employer orientation virtually (i.e. audio-visual) in addition to allowing in-person orientations, based […]

Provider Alert! Provider Information – Patient’s Medicaid Coverage may be Impacted by the end of the COVID-19 Public Health Emergency

Date: June 23, 2022 Attention: All Providers 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 […]

Provider Alert! TMPPM Update for Monoclonal Antibodies Benralizumab, Mepolizumab, and Reslizumab

Date: May 24, 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. […]

Provider Alert! Spikevax COVID-19 Vaccine Coverage Update

Date: June 3, 2022 Attention: All Providers Effective Date: June 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. […]

Provider Alert! Booster Dose Moderna COVID-19 Vaccine for Adults Added to the Formulary

Date: May 31, 2022 Attention: All Providers Effective Date: May 13, 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. […]

Provider Alert! New COVID 19 Diagnosis Codes and Inpatient ICD-10-PCS Procedure Codes

Date: May 17, 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. […]

Provider Alert! Second COVID-19 Vaccine Booster Dose Update

Date: May 13, 2022 Attention: Providers Effective Date: March 29, 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 […]

Provider Alert! Date: Temporary Flexibilities for Nutritional Counseling and Texas Health Steps (THSteps) Checkups Will End When Public Health Emergency Ends

Date: May 5, 2022 Attention: All Providers 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: The purpose […]

Provider Alert! Updated Age Range for COVID-19 Vaccine Administration Procedure Code M0201

Date: May 4, 2022 Attention: All Providers Effective date: Dates of service on or after October 29, 2021 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 […]

Provider Alert! COVID-19 Procedure Code S8301 Reimbursement Documentation Reminder

Date: April 25, 2022 Attention: All Providers 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. TCHP will apply updates and […]

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

Date: March 29, 2022 Attention: All Providers Effective Date: March 29, 2022 The content in this message will remain in effect through April 30, 2022 as announced by the Health and Human Services Commission. 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 […]

Provider Alert! Update to COVID-19 Testing Billing, Modifier QW

Date: March 21, 2022 Attention: Primary Care Providers Effective Date: January 3, 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 […]

Provider Alert! COVID-19 Drug Veklury (Remdesivir) is a covered benefit for Medicaid and CHIP clients

Date: March 3, 2022 Attention: Providers Effective Date: January 21, 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 […]

Provider Alert! COVID-19 Vaccine Administration Procedure Code 0073A is now a Benefit

Date: February 9 , 2022  Attention: All Providers    Effective date: January 3, 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 […]

Provider Alert! Monoclonal Antibody Therapy Procedure Codes for COVID-19 Treatment Added to Texas Medicaid Benefits

Date: February 2, 2022 Attention: All Providers Effective Date: December 8, 2021 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. […]

Provider Alert! COVID-19 Vaccine Booster Update

Date: January 31, 2022 Attention: All Providers Effective Date: January 3, 2022 for Pfizer COVID-19 Vaccine Booster Dose Age Change 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 […]

Provider Alert! Merck Oral COVID-19 drug, Molnupiravir, Added to Formulary

Date: January 24, 2022 Attention: Primary care providers Effective Date: January 3, 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 […]

Provider Alert! COVID-19 Vaccine Administration Code 0004A Update

Date: January 20, 2022 Attention: Primary Care Providers Effective Date: January 3, 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 […]

Provider Alert! Signature Requirement Reinstated on DME Forms

Date: January 19, 2022 Attention: DME Providers Subject: Signature Requirement Reinstated on DME Forms TCHP COVID-19 Utilization Management Procedure and TCHP provider alerts can be found here: http://www.thecheckup.org/provider-alerts/ TCHP network providers should monitor the TCHP Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change […]

Provider Alert! COVID-19 At-home Test Kits Available as a Pharmacy Benefit

Date: January 4, 2022 Attention: All Providers Effective date: January 3, 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. […]

Provider Alert! Pfizer Oral COVID-19 Drug, Paxlovid, Added to Formulary

Date: January 5, 2022 Attention: All Providers Effective Date: December 27, 2021 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. […]

Provider Alert! CHIP Perinatal Members Eligible for COVID-19 Vaccine

Date: December 20, 2021 Attention: All Providers Effective Date: December 11, 2021 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. […]

Provider Alert! Pfizer COVID-19 Vaccine Coverage Update

Date: November 15, 2021 Attention: All Pediatric and Family Medicine Providers Effective Date: October 29, 2021 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 […]

Provider Alert! Update to COVID-19 Monoclonal Antibody Therapy Administration Codes M0245 and M0246

Date: January 3, 2022 Attention: All Providers Subject: Update to COVID-19 Monoclonal Antibody Therapy Administration Codes M0245 and M0246 Effective Date: Dates of service on or after December 3, 2021 for age range expansion Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  […]

Provider Alert! COVID-19 Vaccine Administration Code 0004A Now a Medicaid Benefit

Date: October 18, 2021 Attention: Primary Care Providers Effective Date: Dates of service on or after September 22, 2021 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 […]

Provider Alert! COVID-19 Monoclonal Antibody Therapy Administration Codes: Additional Types and Place of Service

Date: November 1, 2021 Attention: All Providers Effective Date: September 9, 2021 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. […]

Provider Alert! Telehealth Services – PT/OT/ST Providers and COVID-19

Date: September 2, 2021 Attention: All providers. Effective Date: September 7, 2021 Providers should monitor the Texas Children’s Health Plan 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 […]

Provider Alert! Modifier CS: cost sharing for COVID-19 testing and visits

Date: August 11, 2021 Attention: All Providers Effective Date: July 27, 2021 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. […]

Provider Alert! Adolescent Eligibility for Pfizer-BioNTech COVID-19 Vaccine

Date: May 20, 2021 Attention: All Pediatric and Family Medicine Providers Effective Date: May 12, 2021 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 […]

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: […]

Provider Alert! COVID-19 Vaccines Available and Administration

Date: June 30, 2021 Attention: All Providers Updated: May 18, 2021 with home health administration information 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 […]

Provider Alert! New Texas Department of State Health Services COVID-19 Vaccine Resource

Date: April 2, 2021 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. Call to action: Texas Children’s […]

Provider Alert! Reminder – Updated- Approved in-office lab list

Date: September 9, 2021 Attention: All Providers Effective date for procedure code 83655, lead screening: June 22, 2021 Call to action: Texas Children’s Health Plan (TCHP) utilizes Quest Diagnostics as our exclusive reference lab provider. This alert is to serve as a reminder of the specific labs on our pre-approved list that may be run […]

Provider Alert! COVID-19 Monoclonal Antibody Therapy Procedure Code Update

Date: July 19, 2021 Attention: All Providers Effective Date for Procedure code Q0244 is June 3, 2021 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 […]

Provider Alert! Talking with Patient’s about the COVID -19 Vaccination

Date: February 19, 2021 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. Call to action: Texas Children’s […]

Provider Alert! Medicaid, STAR Kids, CHIP, and CHIP Perinatal eligibility during COVID-19

Date: July 23, 2021 Attention: All providers Subject: Medicaid, STAR Kids, CHIP, and CHIP Perinatal eligibility during COVID-19 Effective Date: July 22, 2021 For STAR Kids Age Outs that complete their transitions August 1, 2021. The content in this message on STAR Kids Age-Outs that transitioned on April 1, 2020 will remain in effect through […]

Provider Alert! Providers are encouraged to register to Administer COVID-19 Vaccine

Attention: Primary Care 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 (TCHP) aligns with […]

Provider Alert! COVID-19 Disaster Declaration – COVID-19 Testing expanded to include Out-of- Network (OON) Laboratories

Date: January 7, 2021 Attention: All Provider Notice Effective Date: NEW update for dates of service on or after October 6, 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 […]

Provider Alert! COVID-19 Procedure Codes for the Introduction of Infusion of Therapeutics

Date: January 6, 2021 Attention: All Providers Effective Date: For dates of service on or after August 1, 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 […]

Provider Alert! New Value Point of Origin for Admission of Visit Code “G,” In Use Beginning July 1, 2020 due to the COVID-19

Effective Date: July 1, 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: Texas Children’s Health plan […]

Provider Alert! Utilization Management COVID-19 Procedure Update

Attention: Therapy, LTSS, Private Duty Nursing, and DME Service Providers        Effective Dates: December 1, 2020 and March 1, 2021 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 […]

Provider Alert! HHSC COVID-19 Provider Impact Survey

Attention: All Providers Survey is open now until 5:00 PM on Tuesday, November 10, 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 […]

Provider Alert! CMS Approves Multiple Allowances to Support Providers with Improving Performances and Incentive Payments Alike due to COVID-19 Pandemic

Attention: All Providers Effective Date: August 27, 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: Texas Children’s […]

Provider Alert! THSteps Medical and Dental Checkups during COVID-19

Attention: Primary Care Providers Effective Date: October 22, 2020 The content in this message expired on October 23, 2020, as announced by the Health and Human Services Commission (HHSC). TCHP 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 […]

Provider Alert! HHSC Electronic Visit Verification Temporary EVV Policies for Novel Coronavirus (COVID-19)

Attention: LTSS Providers Effective Date: November 24, 2020    The content in this message will remain in effect through the public health emergency period, extended to December 31, 2020, as announced by the U.S. Health and Human Services Department. TCHP COVID-19 Utilization Management Procedure and TCHP provider alerts can be found here: http://www.thecheckup.org/provider-alerts/ TCHP network […]

Provider Alert! COVID- 19 testing information and resources

Attention: All Providers Effective Date: July 24, 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. The following Provider guidance is […]

Provider Alert! Current Electronic Visit Verification (EVV) users and Financial Management Services Agencies (FMSAs)

Effective Date: 7/10/2020 Call to action: On June 29, 2020, TMHP made improvements to the Electronic Visit Verification (EVV) Portal, posted a new demonstration of the changes, and updated the related training materials. How this impacts providers: Electronic Visit Verification (EVV) users are encouraged to review the updates and improvements to the Electronic Visit Verification […]

Provider Alert! Service Planning for Pregnant Women during COVID-19

Attention: OB/GYN Providers Effective Date: June 26, 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. The content in this […]

Provider Alert! MDCP Interest List Releases postponed through COVID-19 Disaster Declaration Period

Attention: STAR Kids Providers Effective Date: June 26, 2020 The content in this message will remain in effect throughout the COVID-19 Disaster Declaration period as announced by the office of the Texas Governor, Greg Abbott. 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 […]

Provider Alert! New Federal Enhanced Provider Relief Funds for Medicaid and CHIP Providers

Attention: All Providers Effective Date: June 10, 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: Texas […]

Provider Alert! COVID-19/Hydroxychloroquine Prescribing Revised Update from April 2, 2020

Attention: All Providers and Pharmacies Effective Date: June 9, 2020 Call to action: The Texas State Board of Pharmacy has modified the emergency basis rule when dispensing prescriptions for chloroquine, hydroxychloroquine, mefloquine, and azithromycin.  Physicians no longer have to include the diagnosis on the prescription. Additionally, the rule does not prevent a physician from prescribing one of […]

Provider Alert! Texas Medical Board Emergency Rule re: Issuance of Prescriptions During COVID-19 Pandemic

Attention: All Providers and Pharmacies Effective Date: June 12, 2020 Call to action: On June 5, 2020, the Texas Medical Board’s (TMB) Executive Committee, with advice and direction from the Governor’s Office, adopted rules on an emergency basis related to the issuance of certain prescriptions during the COVID-19 disaster. The emergency rule prohibits treatment of chronic pain […]

Provider Alert! Prior authorizations for hospital beds reminder and new codes added

Attention: All Providers Effective date for new codes: August 26, 2020 Call to action: Texas Children’s Health Plan (TCHP) would like to remind you that the following hospital beds and accessories’ codes require prior authorization. This follows the guidance from the Texas Medicaid Provider Procedures Manual (TMPPM).   Code Description E 0184 Dry pressure mattress […]

Register for the June CME: COVID-19 Looking to the Future

COVID-19 – Looking to the Future: Where are we now and where do we go from here? Presented by Texas Children’s Health Plan Wednesday, June 17, 2020 – 5:30-7:30 p.m. – Live stream via WebEx Topics covered will include: Progress toward a COVID-19 Vaccine Fall 2020: Managing COVID-19 and the Flu in a Pediatrics Practice […]

Provider Alert! Families First Coronavirus Response Act Information

Attention: Financial Management Services Agencies and Consumer Directed Services employers Effective Date: This rule is in effect April 2, 2020 to December 31, 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 […]

Provider Alert! COVID-19 Medicaid Pharmacy Benefit Updated May 4, 2020

Attention: All Providers and Pharmacies Effective Date: May 4, 2020 The Texas Vendor Drug Program (VDP) has implemented several changes in response to COVID-19. This notice contains the latest updates, as well as links to the previously implemented changes. No-auto prior authorization (NAP) designation temporarily lifted: Normally, medications listed as NAP on the drug formulary […]

Provider Alert! Association for Community Affiliated Plans (ACAP) webinar on small business relief

Attention: All Providers Effective: April 15, 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: TCHP would […]

COVID-19 Disaster Declaration – ALERT #4 – Prior Authorization Adjustments

Attention: All Provider Notice Effective Date: April 13, 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: […]

Provider Alert! Provider resources: Coronavirus Aid Relief and Economic Security (CARES) ACT and more

Attention: All Providers Effective Date: March 27, 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: TCHP […]

Provider Alert! COVID-19 Disaster Declaration – ALERT #3 – Prior Authorization Adjustments

Attention: All Providers Effective Date: April 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: […]

Provider Alert! COVID-19 Guidance: UPDATE ALERT #5 Telehealth Services: Targeted Case Management through remote delivery

Attention: Behavioral Health, OB/GYN, and ECI Providers Effective Date: April 24, 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 […]

Provider Alert! Pharmacy Updates Related to COVID-19

Attention: All Providers and Pharmacies Effective Date: March 20, 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 […]

Provider Alert! COVID-19 Disaster Declaration – ALERT #2 – Prior Authorization Adjustments

Attention: All Providers Effective Date: April 1, 2020 Providers should monitor the Texas Children’s Health Plan 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: As are […]

Provider Alert! UPDATE ALERT #3 –Telehealth Services – PT/OT/ST; FQHC/RHC Providers and COVID-19

Attention: All Providers Effective Date: March 31, 2020 Providers should monitor the Texas Children’s Health Plan 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 […]

Provider Alert! Select an EVV Vendor System or EVV Proprietary System Update

Attention: Financial Management Services Agencies (FMSA) Effective Date: May 1, 2020 Due to impacts of coronavirus, HHSC is extending the deadline to May to select an EVV system and begin the onboarding process. The original deadline was April 1,2020. Therefore, Financial Management Services Agencies (FMSAs) must select an Electronic Visit Verification or EVV Vendor System or […]

Provider Alert! COVID-19 Disaster Declaration – Texas Children’s Health Plan Operational Adjustments

Attention: All Providers Effective Date: March 13, 2020 TCHP affiliated providers should monitor the 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: Reporting adjustments […]

Provider Alert! COVID-19 Disaster Declaration – Prior Authorization Adjustments

Attention: All Providers Effective Date: March 18, 2020 TCHP affiliated providers should monitor the 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: As are […]

Provider Alert! Update – Telemedicine & Telehealth Services and COVID-19

Attention: All Providers Effective Date: March 17, 2020 Texas Children’s Health Plan supports the delivery of telemedicine and telehealth services to its members. As part of our COVID-19 Emergency Response, Texas Children’s Health Plan will add coverage of telemedicine services that are provided through only synchronous audio interactions (audio-only telephone consultation). How this impacts providers: […]

Provider Alert! Coronavirus disease 2019 (COVID-19) and Pregnancy

The following provider guidance is provided as a Texas Children’s Health Plan (TCHP) educational communication only. As many of our network providers are affiliated with other institutions and organizations who also set policy and procedure, this communication is not intended to replace, overwrite, amend or append to another institution’s guidance, policy or procedure. TCHP reserves […]

Provider Alert! Reporting Provider Office Closures and Changes due to COVID-19

Attention: All Providers Effective March 17, 2020 Reporting Provider Office Closures and Changes due to COVID-19 The severity of the Coronavirus disease 2019 (COVID-19) may have affected your ability to operate during normal business hours. If your office has made any changes to the regular business operations or has closed entirely and unable to provide services […]