Tag - claims

Provider Alert!
06Apr

Provider Alert! Update: New Edit Implemented by Claims Processor, Change HealthCare

Date: April 5, 2021 Attention: All Providers Effective Date: March 25, 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: This is an update to communication we previously posted: For network providers that have submitted institutional claims, (UB04 837I) from February 16, 2021 through March 25, 2021...

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Provider Alert!
17Feb

Provider Alert! Transport to and from Shelters

Date: February 17, 2021 Attention: Ambulance Transport Companies Effective Date: February 15, 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: In response to the current weather conditions, effective February 15 through February 19, 2021, Texas Children’s Health Plan will reimburse for ambulance transportation of technology...

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Provider Alert!
23Oct

Provider Alert! Texas Children’s Health Plan Special Investigations Unit and Claims Payment Review Information

Attention: All Providers Effective Date: October 23, 2020 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) would like to share information with our provider network on two important topics, the Special Investigation Unit and Claims Payment Reviews. What is the Special...

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Provider Alert!
07Oct

Provider Alert! Correction for new claim requirement

Effective October 1, 2019, all claims submitted to Texas Children’s Health Plan must be submitted with the member’s state provided Medicaid Identification Number and date of birth on the claim. Providers should confirm the Medicaid Identification Number is submitted in block {1a} for CMS-1500 forms and block {60} of a CMS 1450 (UB-04). For electronic claims, the member Medicaid Identification Number should be submitted in Loop 2010BA for either the 837P or 837I.The member’s date of birth must also be included. Claims...

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Provider Alert!
15May

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 necessity. What...

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Provider Alert!
12Oct

Provider Alert! Texas Children’s Health Plan Claim Editing System Update

Attention:  All Providers Subject: Texas Children’s Health Plan Claim Editing System Update Effective: 12/27/2018   Texas Children’s Health Plan intends to transition to a new Claims Editing System (CES) by Optum on 12/27/2018. Please be aware that claims submitted prior to 12/27/2018 will continue to be processed by our current vendor, McKesson Claim Check. TCHP is required by Texas Health and Human Services to ensure all required claims edits are consistently applied. Migrating to Optum CES will enable TCHP to efficiently apply all required coding...

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Provider Alert!
01Sep

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/ referring...

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20Jun

Hospital – Facility Billing Neonatal Claims Must Submit Application for Neonatal Level of Designation before July 1, 2018

Attention:  All Hospitals Subject:  Hospitals Billing Neonatal Claims Must Submit Application for Neonatal Level of Designation before July 1, 2018 Effective immediately, hospitals rendering neonatal services must submit their neonatal designation applications to the Texas Department of State Health Services. Completed applications must be submitted before July 1, 2018. Applications received after July 1 will not be considered for approval. If an application is received after July 1, it will not be considered as submitted in time for approval by the executive commissioner before...

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Provider Alert!
30Jan

Provider Alert! EVV Prospective Process: what is it?

Attention:  All TCHP STAR Kids LTSS Providers Requiring EVV Subject:  TCHP EVV Prospective Process   Beginning 05/01/2018, Texas Children’s Health Plan will activate the Prospective Process for the EVV system. This process will match claims to EVV transactions prior to the claim being paid. If a matching EVV transaction is not found, the claim will be denied. It is imperative that all providers ensure that all members have the correct payor ID set up in the EVV software. If a member does not...

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14Mar

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 the...

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