Tag - billing

Provider Alert!

Provider Alert! Clarification for the STAR Kids LTSS Billing Matrix Revisions

Date: June 6, 2022                         Attention: STAR Kids 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. TCHP will apply updates and reprocess impacted claims as soon as possible. However, please allow up to sixty (60) business days for reprocessing. Providers [...]

Provider Alert!

Provider Alert! Clarification for the STAR Kids LTSS Billing Matrix Revisions

Date: June 6, 2022                        Attention: STAR Kids 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. TCHP will apply updates and reprocess impacted claims as soon as possible. However, please allow up to sixty (60) business days for reprocessing. Providers [...]

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 event. Regarding system configuration updates, TCHP will apply updates and reprocess impacted claims as soon as possible. However, due to volume, please allow up to sixty (60) business [...]

Provider Alert!

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. Call to action: Texas Children’s Health Plan (TCHP) aligns with the Healthcare Common Procedure Coding System (HCPCS) additions, revisions, and discontinuations that are implemented for claims processing by [...]

Provider Alert!

Provider Alert! New Provider Type for Non-Local Mental Health Authority Providers of Mental Health Targeted Case Management/Rehab

Date: October 19, 2021 Attention: Billing Services for Behavioral Health Providers (Non-LMHAs) Subject: New Provider Type for Non-Local Mental Health Authority Providers of Mental Health Targeted Case Management/Rehab Deadline for provider enrollment: 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 of the COVID-19 event. Call to action: Texas Children’s [...]

Provider Alert!

Provider Alert! Reminder of mailing address and procedure for overpayments

Attention: All Providers Effective Date: March 20, 2020 Should a provider receive an overpayment from Texas Children’s Health Plan they should immediately take the following action. A provider has an obligation to notify Texas Children’s Health Plan in writing upon identification of an overpayment, no more than thirty (30) days from the date of discovery. The overpayment can be remediated through refund to Texas Children’s Health Plan, or a provider may request a recoupment from future claim payments.   For refunds: If a provider [...]

Provider Alert!

Provider Alert! Follow-up on Billing Provider Taxonomy Claims Requirement Effective September 1, 2018

Clearing House Process Verification: Please verify with your clearing house that the TMHP attested billing provider taxonomy is being transmitted on claims for all products. Through collaborative work with provider groups, it has been identified that some clearing houses have been removing the billing taxonomy code on claims prior to submitting to the health plan for processing resulting in claims denials. Billing provider taxonomy is a requirement effective 9/1/2018. Because providers use a variety of clearing houses for claims submission, your [...]

Provider Alert!

Provider Alert! STAR Kids Billing Requirements

Attention: STAR Kids Providers REMINDER: STAR Kids Billing Requirements   As previously communicated, Texas Children’s Health Plan (TCHP) requires all STAR Kids providers billing for private duty nursing (PDN) services with the T1000 CPT code to use the billing matrix available on the Texas Health and Human Services website at https://hhs.texas.gov/laws-regulations/handbooks/star-kids-handbook/appendices/appendix-iii-ltss-billing-matrix-crosswalk. This requirement was effective June 5, 2017.   Failure to use this billing matrix, including placement of modifiers, will result in denials for incorrectly billed services.  Providers may receive line denials if [...]

Provider Alert!

Provider Alert! New Claims Requirements Effective September 1, 2018

Date: August 20, 2018 New Claims Requirements Effective September 1, 2018 Attention:  Network Providers   Billing taxonomy Per section 6.2.1 of the TMPPM Billing providers must submit the taxonomy number on all electronic claims with the exception of Medicare primary claims. Electronic claims without a billing taxonomy will be rejected.   Claim Requirement Electronic Claim Billing Provider Taxonomy Code (required on all claims) 2000A, PRV03   Ordering/Referring Provider Requirement For services that require an ordering/referring provider the NPI of the ordering/referring provider must be attested. Billing providers can verify an ordering/ [...]

Reimbursement code for sports and camp physicals

Effective January 1, 2017, Texas Children’s Health Plan began reimbursing code 97169 – Athletic Training Evaluation, low complexity, as a value added service to CHIP and STAR Members under 21. This code is only reimbursed for sports and camp physicals when a member has also had a THSteps or well child visit within the previous 12 months. Code 97169 will be the only code that is accepted for reimbursement; use of any other Athletic Training Evaluation code (such as [...]