Tag - claims processing

Provider Alert!

Provider Alert! DME/Supplies Exceeding Medicaid Limitations

Texas Children’s Health Plan applies benefit limitations for DME Supplies and Equipment per the current TMHP Manual for all members eligible to receive the benefit. See benefit exceptions below. Frequency of Billing As a reminder, DME monthly limits will be applied every 27 days. Claims for recurring DME rentals and/or monthly disposable supplies billed prior to this renewal date are subject to denial.  Denied claims may be appealed through the standard appeal process with supporting documentation to establish and/or support medical [...]

Provider Alert!

Provider Alert! Therapy Modifiers

Therapy modifiers A modifier must be used to indicate when treatment services have been rendered by a licensed therapist/ physician or a therapy assistant under supervision of a licensed therapist. The following modifiers are not required for evaluation or re-evaluation codes because those services may not be rendered by therapy assistants. UB – Services delivered by a licensed therapy assistant under supervision of a licensed therapist. U5 – Services delivered by a licensed therapist or physician. Claims for co-treatment services must be submitted with [...]

Provider Responsibilities

As a reminder, demographic changes must be sent in writing to Texas Children’s Health Plan within a minimum of 30 calendar days. Changes not received in writing are not valid. Texas Children’s Health Plan and its designated claims administrator are not responsible for potential claims processing and payment errors due to failure to update information. Notification of change should be made to Texas Children’s Health Plan Provider Relations and Care Coordination at the following email address: tchpprovrel@texaschildrens.org, or by [...]