Tag - Coding

Provider Alert!

Provider Alert! Screening and Coding for Social Determinants of Health

table { border-collapse: collapse; }tr,td { border: solid thin; } Attention: Primary Care and Obstetric Care Providers 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: As stewards of our member’s care, Texas Children’s Health Plan (TCHP) would like to raise your awareness of [...]

Provider Alert!

Provider Alert! Second Quarter 2020 HCPCS Updates for Texas Medicaid

Attention: All Providers Effective Date: July 1, 2020 Call to action: Texas Children’s Health Plan (TCHP) aligns with the Healthcare Common Procedure Coding System (HCPCS) additions, revisions, and discontinuations that are implemented for claims processing by TMHP for Texas Medicaid. How this impacts providers: Second Quarter 2020 HCPCS Added Procedure Codes are as follows: Clinician Administered Drug (CAD) Procedure Codes C9061 J0223 J0691* J0742 J0791* (replacing C9053) J0896  J7169* J7204 J9177 J9246 J9358 Q5119 Q5120     The follow codes have age restrictions: J1201 – 6 months and older J1558 – 2 years and older J0791 – 16 years and older J0223, J0691, [...]

Provider Alert!

Provider Alert! Second Quarter National Correct Coding Initiative updates

Call to action: Texas Children’s Health Plan (TCHP) supports the National Correct Coding Initiative (NCCI) updates that are implemented for claims processing by TMHP for Texas Medicaid. How this impacts providers: For Health and Behavior Assessment and Intervention (HBAI), codes 96170 and 96171 will no longer be reimbursed after April 1, 2020. Procedure codes 96167 and 96168 will be the only codes for HBAI, which include the member’s family,  that may be reimbursed when the family member directly participates in [...]

Provider Alert!

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 [...]

Provider Alert! Coding Changes to Postpartum Depression Screening

Maternal depression is a serious and prevalent condition that not only affects the mother, but may present a substantial early risk to appropriate child development, the mother-infant bond, and the family. According to the AAP, it has been estimated that 5 percent to 25 percent of all pregnant, postpartum, and parenting women have some type of depression. Mothers who have low incomes are more likely to experience some form of depression than the general population of mothers. A maternal [...]

Immediate postpartum long-acting reversible contraceptives (LARCs): claim processing procedure update

Long-acting reversible contraceptives (LARCs) are beneficial to subsequent maternal health outcomes as they enhance family planning and safer birth spacing. The Texas Medicaid Provider Procedures Manual was updated earlier this year to reflect new language related to immediate postpartum LARC device insertion. Language in subsection 2.2.5.4, “Immediate Postpartum Insertion of IUDs and Implantable Contraceptive Capsules” was updated regarding immediate postpartum LARC insertion and claim processing procedures. The new language states that procedure codes for LARCs may be reimbursed in addition [...]

HEDIS Spotlight: Prenatal / Postpartum Care

HEDIS stands for Healthcare Effectiveness Data and Information Set. It is a widely used set of performance measures by the nation’s health plans, and an essential tool in ensuring that our members are getting the best healthcare possible. It is extremely important that our providers understand the HEDIS® specifications and guidelines. In this section of The Checkup we will highlight different HEDIS metrics. We will provide a description of the measures, the correct billing codes to support services rendered [...]