Tag - claims

Provider Alert!

Provider Alert! EVV Claims Matching Bypass from January 1 to March 31, 2024

Date: February 9, 2024 Attention: STAR Kids Providers/Consumer Directed Services employers and FMSA Providers Effective: March 31, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that the Texas Health and Human Services Commission (HHSC) implemented a claim matching bypass on February 1, 2024 — for EVV claims with dates of service from January 1 through March 31 — to be paid without a matching EVV visit. Program providers, financial management services agencies (FMSAs), and Consumer Directed Services...

Provider Alert!

Provider Alert! Temporary Extension to Submit Claim Appeals

Date: June 8, 2023 Attention: All Providers Texas Children’s Health Plan (TCHP) would like to notify providers that the timely filing deadline for claim appeals has been waived for Dates of Service: August 1, 2022 – July 31, 2023. TCHP is conducting a provider reimbursement review to ensure accurate provider payments following the implementation of our new claims processing system, Epic Tapestry, on August 1, 2022.  Claims identified with erroneous payments will automatically be adjusted. However, providers may also submit or resubmit appeals...

Provider Alert!

Provider Alert! Retracted: Coordination of Benefits for Utilization Management Update

Date: April 19, 2023 Attention: All Providers Call to action:  As you may remember, Texas Children’s Health Plan (TCHP) previously communicated changes to our Coordination of Benefits Procedure on February 15, 2023. After careful consideration and listening to your concerns, the Utilization Management (UM) team has decided to pause on any changes and revert back to the original procedure. A link to the former procedure that is currently being followed is available here. How this impacts providers: Providers that received a rejection letter due...

Provider Alert!

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

Date: March 23, 2023 Attention: All Providers Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that we have corrected the internal system error that was previously reported. The error impacted claims processing beginning February 27- March 7, 2023. All impacted claims from this time span have been reprocessed. The erroneous EOP message related to these claims was, “This Provider was not certified/eligible to be paid for this procedure/service on this date of service.” Claims impact report: Your assigned...

Provider Alert!

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...

Provider Alert!

Provider Alert! Claims Editing System Reminder

Date: March 8, 2023 Attention: All Providers Call to action: As a reminder, providers are required to bill following the guidance of the CMS and Texas Health and Human Services guidelines. All providers should stay current with these guidelines. Medicaid National Correct Coding Initiative (NCCI) edits may be found at: https://www.medicaid.gov/medicaid/program-integrity/ncci/edit-files/index.html Next steps for providers: Providers should share this communication with their billing staff and confirm that their claims processing systems are configured correctly according to the guidelines provided in the links above. If...

Provider Alert!

Provider Alert! Claims submitted prior to August 1, 2022 Viewable on Texas Children’s Link

Date: January 24, 2023 Attention: All Providers Date claims are available: January 26, 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. Call to action: We previously communicated to you that claims with a submission date prior to August 1, 2022 were not available to you in Texas Children’s...

Provider Alert!

Provider Alert! Telemedicine/Telehealth claims guidance

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 Services Commission.The content in this message on Rural Health Clinics as telehealth and telemedicine sites will remain in effect through March 31, 2022 as announced by the Health...

Provider Alert!

Provider Alert! Reminder of Updated Rendering Provider Edit Requirements

Date: November 10, 2022 Attention: All Providers Effective Dates: June 21, 2022 for rendering edit requirements Further clarification provided: November 10, 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 the nature of the COVID-19 Event. Call to action: Texas Children’s Health Plan (TCHP) would like to remind providers of billing requirements for the...

Provider Alert!

Provider Alert! Telemedicine/Telehealth claims guidance

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 Services Commission. The content in this message on Rural Health Clinics as telehealth and telemedicine sites will remain in effect through March 31, 2022 as announced by the Health...