Tag - claims

Provider Alert!
26Mar

Provider Alert! Billing EVV Services as Secondary Insurance Claims

Date: March 26, 2024 Attention: STAR Kids Providers/Consumer Directed Services employers and FMSA Providers Call to action: Texas Children’s Health Plan (TCHP) would like to share updates to the process of billing secondary insurance for program providers and financial management services agencies (FMSAs). With the implementation of EVV for the Home Health Care Services on January 1, 2024, concerns were brought forward regarding the billing EVV services as secondary insurance claims. Specifically, it was shared that a reason for denial is needed from...

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Provider Alert!
26Mar

Provider Alert! Availity Now Offered to Providers for Electronic Claims Submission

Date: March 26, 2024 Attention: All Providers Effective Date: March 25, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to announce that Availity is now available as a clearinghouse option for electronic claims submissions. Getting Started with Availity: If a provider already uses Availity as a clearinghouse, then claims will route to TCHP payer IDs as normal (payer ID information can be found in the TCHP Institutional Guide and TCHP Professional Guide). No additional action is required. If a provider uses Change Healthcare...

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Provider Alert!
07Mar

Provider Alert! EVV Claims Matching Resumes April 1, 2024; Unmatched EVV Claims will Deny for Payment

Date: March 7, 2024 Attention: STAR Kids Providers/Consumer Directed Services employers and FMSA Providers Effective Date: April 1, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that Texas Health and Human Services Commission (HHSC) implemented a claim matching bypass on February 1, 2024 – for Electronic Visit Verification (EVV) claims with dates of service from January 1 through March 31 – to be paid without a matching EVV visit. EVV claims matching for all services required to use...

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Provider Alert!
09Feb

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...

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Provider Alert!
08Jun

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...

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Provider Alert!
19Apr

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...

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Provider Alert!
23Mar

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...

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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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Provider Alert!
08Mar

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...

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Provider Alert!
25Jan

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...

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