Tag - billing

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 [...]

Updated STAR Kids billing matrix effective June 5, 2017.

Updated STAR Kids billing matrix effective June 5, 2017. Updates include: Registered nurse modifier (TD) to the private duty nursing (PDN) billing code, T1000 Billing codes for PDN independently enrolled LVNs and RNs are included in the matrix Revenue code 663 was added to the out-of-home respite codes. Please note that failure to use this billing matrix will result in denials for incorrectly billed services. For more information on this topic, visit http://www.texaschildrenshealthplan.org/for-providers .

Provider Alert!

Provider Alert! STAR Kids Billing Matrix

Attention STAR Kids Providers Effective 06/05/2017 Updated STAR Kids Billing Matrix The STAR Kids billing matrix has been updated to include the registered nurse modifier (TD) to the private duty nursing (PDN) billing code, T1000. Additionally, the billing codes for PDN independently enrolled LVNs and RNs have been added to the matrix. The Revenue Code 663 was added to the Out-of-Home Respite codes. This billing matrix will become effective for dates of service June 5, 2017 and forward. Failure to use [...]

New Texas Children’s Health Plan provider portal features added

Texas Children’s Health Plan has been actively adding new features to the provider portal located at www.tchp.us/providers Providers can continue to view eligibility, claim status, authorizations and all of our provider news. In addition, providers are able to view the named Service Coordinator for STAR Kids members and submit claim appeals online. The named Service Coordinator for STAR Kids members can be found on the member enrollment information screen under additional information. The Texas Children’s Health Plan Service Coordinator serves as [...]

Provider Alert! Long Acting Reversible Contraception (LARC) Billing Changes

To: All Providers and Facilities Subject: Long Acting Reversible Contraception (LARC) Billing Changes Recent changes at Health and Human Services Commission (HHSC) has improved the accessibility of LARC devices for Medicaid members. HHSC is currently working to add ParaGard, Nexplanon and Liletta to the Medicaid Vendor Drug Program formulary. More information on these products and the process to order will be supplied as these are added. Once added, providers may choose to continue to “buy and bill” or they may choose [...]