Provider Alerts

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

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

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. […]

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. […]

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 […]

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 […]

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 […]

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: […]

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 […]

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 […]

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 […]

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 […]

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 […]

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 […]

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 […]

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 […]

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 […]

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 […]

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 […]

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 […]

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 […]

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 […]

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

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

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 […]

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 […]

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 […]

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 […]

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 […]

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 […]

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 […]

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 […]

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 […]

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 […]

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 […]

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 […]

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 […]

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: […]

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, […]

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 […]

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 […]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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. […]

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 […]

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 […]

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. […]

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. […]

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 […]

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. […]

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 […]

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 […]

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. […]

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. […]

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 […]

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. […]

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. […]

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. […]

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. […]

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. […]

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 […]

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 […]

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. […]

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 […]

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 […]

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 […]

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. […]

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 […]

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 […]

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. […]

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. […]

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. […]

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 […]

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 […]

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 […]

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. […]

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 […]

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 […]

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 […]

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. […]

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. […]

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. […]

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 […]

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 […]

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 […]

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. […]

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 […]

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 […]

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 […]

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. […]

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 […]

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 […]

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 […]

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. […]

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 […]

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 […]

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. […]

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 […]

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 […]

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 […]

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 […]

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 […]

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.  […]

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.  […]

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. […]

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 […]

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 […]

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 […]

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 […]

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 […]

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 […]

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 […]

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 […]

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. […]

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 […]

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 […]

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. […]

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 […]

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 […]

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 […]

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: […]

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 […]

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 […]

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 […]

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 […]

  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 […]

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: […]

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 […]

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 […]

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 […]

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 […]

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 […]

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 […]

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 […]

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 […]

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 […]

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 […]

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 […]

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 […]

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: […]

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 […]

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 […]

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 […]

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 […]

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 [...]

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 […]

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 […]

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 […]

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 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. […]

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 […]

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 […]

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 […]

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 […]

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 […]

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 […]

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 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.

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 […]

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

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 […]

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 […]

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 […]

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

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 […]

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 […]

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 […]

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 […]

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 […]

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 […]