Tag - Coding

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 [...]