Tag - appeals

Provider Alert!
12Apr

Provider Alert! Appealing Legacy Claims within our Provider Portal, Texas Children’s Link

Date: April 10, 2023 Attention: All Providers Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers utilizing Texas Children’s Link, our online provider portal, how to access and appeal legacy claims within this platform. Legacy Claims are defined as claims with a submission date prior to August 1, 2022.   Click here for the steps to access and appeal legacy claims. We hope this option improves your daily operations and makes the claims reconciliation process much easier. Background information: Texas...

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22Mar

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 services provided beginning May 12, 2023, and ongoing, the normal policy of allowing no less than 90 calendar days and no more than 120 calendar days from...

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Provider Alert!
10Mar

Provider Alert! Recent Claim Denials Issued in Error are now Being Corrected

Date: March 10, 2023 Attention: All Providers Call to action: Texas Children’s Health Plan (TCHP) is currently addressing recent claim denials that originated from an internal system error. How this impacts providers: No action is required by Providers. TCHP is working diligently to have the system corrected and will reprocess all impacted claims that denied in error by March 24, 2023. The EOP Message for impacted claims: This Provider was not certified/eligible to be paid for this procedure/service on this date of service. Next...

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13Feb

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 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...

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17Jan

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

Date: December 29, 2022 Attention: All providers Effective Date: December 9, 2022 The content in this message will remain in effect through March 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 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...

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12Dec

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 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...

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Provider Alert!
08Dec

Provider Alert! Inpatient Prepayment Review Program

Date: December 6, 2022 Attention: Hospital Providers and Inpatient Facilities Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  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 of this communication is to address some of the questions we have been receiving related to prepayment claims reviews.  Texas Children’s Health Plan (TCHP)...

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22Nov

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 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...

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Provider Alert!
01Jul

Provider Alert! End of Reconsideration Process for Denied services

Date: July 1, 2022 Attention: All Providers   Effective date: August 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. TCHP will apply updates and reprocess impacted claims as soon as possible. However, please allow up to sixty (60) business days for reprocessing. Providers are not required to...

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