clinical prior authorization

02FebFebruary 2, 2024

Provider Alert! Clinical Implementation of Hormonal Therapy Agents Clinical Prior Authorization Effective March 1, 2024

Date: February 1, 2024 Attention: All Providers Effective Date: March 1, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective March 1, 2024, the Texas Health and Human Services (HHSC) will implement clinical prior authorizations to hormonal therapy agents. HHSC will implement criteria for the following procedure codes: J1000 (depo-estradiol cypionate, up to 5mg) J1071 (inj testosterone cypionate, 1 mg) J1380 (inj estradoiol valerate, up to 10 mg) J1950 (inj leuprolide acetate, per 3.75 mg) J1951 (inj leuprolide acetate, fensolvi, 0.25...

By Texas Children's Health PlanOB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialistsclinical prior authorization, hormonal therapy0 CommentsRead more...

05DecDecember 5, 2023

Provider Alert! Synagis (palivizumab) Clinical Prior Authorization Forms Updated with Revised Abrysvo Criteria

Date: December 4, 2023 Attention: All Providers Effective date: November 17, 2023 Call to action: On November 17, 2023, Health and Human Services Commission (HHSC) updated the Synagis Standard Prior Authorization Request (HHS Form 1321) to include a step to check for Abrysvo vaccine administration to the client’s mother during 32 to 36 weeks of pregnancy. How this impacts providers: Additional information on Abrysvo Vaccine include the following: Abrysvo is indicated for active immunization of pregnant individuals at 32 through 36 weeks gestational age for...

By Texas Children's Health PlanOB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialists, UncategorizedAbrysvo, clinical prior authorization, Synagis, vaccine0 CommentsRead more...

08SepSeptember 8, 2023

Provider Alert! Updated Clinical Prior Authorizations Criteria Guides

Date: September 8, 2023 Attention: All Providers Effective Date: July 31, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that the Texas Health and Human Services (HHSC) updated multiple clinical prior authorization criteria guides effective July 31, 2023. How this impacts providers: HHSC updated the following clinical prior authorization criteria guides with the noted changes: Anxiolytics/Sedatives/Hypnotics (ASH) Ramelteon Corrected step 4 in the Ramelteon criteria logic and diagram. Diazepam Added GCNs for diazepam (45092, 14210) to the prior authorization table Cytokine...

By Texas Children's Health PlanOB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialistsclinical prior authorization, Clinical Prior Authorization Criteria0 CommentsRead more...

07AugAugust 7, 2023

Provider Alert! Implementation of Sotyktu Criteria in Cytokine and CAM Antagonists Clinical Prior Authorization

Date: August 4, 2023 Attention: All Providers Effective Date: July, 27 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective July, 27 2023, the Texas Health and Human Services Commission (HHSC) implemented criteria for Sotyktu®. Sotyktu® belongs to the Cytokine and CAM Antagonists class and is indicated for the treatment of moderate-to-severe plaque psoriasis in adults who are candidates for systemic therapy or phototherapy. How this impacts providers: The new criteria is available on the HHSC...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, SpecialistsCAM Antagonists, clinical prior authorization, cytokine, Sotyktu0 CommentsRead more...

20JunJune 20, 2023

Provider Alert! HHSC to Add New Qulipta® Indication to Clinical Prior Authorization

Date: June 20, 2023 Attention: All Providers Effective Date: June 27, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective June 27, 2023, Texas Health and Human Services (HHSC) will follow the Food and Drug Administration’s recent approval of new indication for atogepant (Qulipta®), to prevent chronic migraine in adults. How this impacts providers: Starting June 27, 2023, TCHP will implement the new indication for atogepant (Qulipta®) to prevent chronic migraine in adults. The new criteria...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialistsclinical prior authorization, Qulipta0 CommentsRead more...

09JunJune 9, 2023

Provider Alert! HHSC to Implement Pulmonary Hypertension Agents Clinical Prior Authorization on July 27, 2023

Date: June 9, 2023 Attention: All Providers Effective Date: July 27, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective July 27, 2023, Texas Health and Human Services (HHSC) will be implementing clinical prior authorization criteria for Pulmonary Hypertension Agents. How this impacts providers: Starting July 27, 2023, TCHP will implement the Pulmonary Hypertension Agents clinical prior authorization criteria. Updated prior authorization (PA) forms will be accessible on Navitus. It is crucial for all providers to...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialistsclinical prior authorization, Pulmonary Hypertension Agents0 CommentsRead more...

09JunJune 9, 2023

Provider Alert! Clinical Prior Authorization Criteria Updates

Date: June 9, 2023 Attention: All Providers Effective Date: March 23, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that the Texas Health and Human Services (HHSC) will be implementing updated clinical prior authorization criteria for Allergen extracts, IIleal Bile Acid Transporter (IBAT) Inhibitors and Monoclonal Antibody Agents. Allergen Extracts Palforzia is indicated for an allergic reaction that may occur with accidental exposure to peanut. Palforzia will require clinical criteria similar to that of other allergen extracts. The...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialistsclinical prior authorization, IBAT, Illeal Bile Acid Transporter, Monoclonal Antibody0 CommentsRead more...

01JunJune 1, 2023

Provider Alert! HHSC to Implement Gattex® Clinical Prior Authorization on June 6, 2023

Date: May 31, 2023 Attention: All Providers Effective Date: June 6, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective June 6, 2023, Texas Health and Human Services (HHSC) will be implementing the Gattex® clinical prior authorization criteria, which was approved on April 28, 2023. How this impacts providers: Starting June 6, 2023, TCHP will implement the Gattex® clinical prior authorization criteria. The new criteria is available on the HHSC Vendor Drug Program website and can...

By Texas Children's Health PlanOB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialistsclinical prior authorization, Gattex, hhsc, VDP0 CommentsRead more...

11MayMay 11, 2023

Provider Alert! Implementation of Hereditary Angioedema (HAE) Agents Clinical Prior Authorization for Fee for Service Scheduled for April 11

Date: May 10, 2023 Attention: Providers Effective Date: April 11, 2023 Call to action: Effective April 11, 2023 Texas Health and Human Services Commission (HHSC) added Takhzyro generic code (GCN) 39478 to the drugs requiring Hereditary Angioedema (HAE) clinical prior authorization for clients enrolled in Medicaid Fee-For-Service. How this impacts providers: Prescribers will now have to submit a prior authorization for Takhzyro® for their Medicaid fee-for-service population. Next steps for providers: Prescribers should share this communication with their staff. Provider must submit documentation (such as...

By Texas Children's Health PlanOB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialistsclinical prior authorization, Fee for Service, HAE, Heredity Angioedema Agents, Takhzyro0 CommentsRead more...

25AprApril 25, 2023

Provider Alert! Olumiant Clinical Prior Authorization Revision Effective March 27

Date: April 21, 2023 Attention: All Providers Effective Date: March 27, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective March 27, 2023, the Health and Human Services Commission (HHSC) revised the clinical prior authorization approval criteria for Olumiant, a Janus Kinase (JAK) Inhibitor. Olumiant is prescribed for adults with severe alopecia areata and adults with moderate to severely active rheumatoid arthritis. The prior authorization approval criteria revisions were made to match the information in the...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialistsalopecia, clinical prior authorization, Olumiant, rheumatoid arthritis0 CommentsRead more...

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