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! 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! 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! 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 […]
