Tag - Dental

Provider Alert! THSteps Medical and Dental Checkups during COVID-19

Attention: Primary Care Providers Effective Date: October 22, 2020 The content in this message expired on October 23, 2020, as announced by the Health and Human Services Commission (HHSC). TCHP COVID-19 Utilization Management Procedure and TCHP provider alerts can be found here: http://www.thecheckup.org/provider-alerts/ 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 [...]

Provider Alert!

Provider Alert! Dental Varnish Services

Date: October 16, 2019 Attention: Primary Care Providers Subject: Dental Varnish Services Call to action: Texas Children’s Health Plan (TCHP) identified an error in the reimbursement of dental varnish services.  This error may have resulted in non-payment of this service during a medical checkup for TCHP members who are 6 to 35 months of age.  An update to TCHP’s claims payment system is currently in process and all impacted claims will be reviewed and reprocessed for payment within the next 30 days. How [...]

Dental caries and fluoride varnish: not just for dentists

Dental caries remains the most common chronic disease of childhood in the United States.  In fact, dental caries affects more than half of Texas children. Primary care providers play a key role in the prevention of dental caries. To help ensure dental health, all children 6 months of age and older should be referred to a dental home. Additionally, periodic oral evaluations and application of fluoride varnish in the medical home during well child or THSteps exams can help [...]

Modifier Change for Dental General Anesthesia

Note: Texas Medicaid managed care organizations must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, pre-certification, referrals and claims/encounter data filing may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the client's specific MCO for details. Pending final approval of the Nov. 16, 2017 rate hearing adjustments, the modifier to be submitted with services related to dental general anesthesia will change for Texas Medicaid. This change will be [...]

Provider Alert!

Provider Alert! Prior Authorization of Texas Health Steps (THSteps) dental therapy under general anesthesia for members who are six years of age or younger

Effective July 1, 2017, Texas Children’s Health Plan will be required to implement prior authorization for Level 4 deep sedation and general anesthesia provided in conjunction with therapeutic dental treatment for Medicaid dental clients from ages 0 through six years. All Level 4 services must be authorized prior to rendering services. Anesthesia services provided by a dentist should use procedure code D9223. Any anesthesia services provided by an anesthesiologist (M.D./D.O.) or certified registered nurse anesthetist (CRNA), should use procedure code [...]

Prior Authorization of Texas Health Steps (THSteps) dental therapy under general anesthesia for members who are six years of age or younger

Effective July 1, 2017, Texas Children’s Health Plan will be required to implement prior authorization for Level 4 deep sedation and general anesthesia provided in conjunction with therapeutic dental treatment for Medicaid dental clients from ages 0 through six years. All Level 4 services must be authorized prior to rendering services. Anesthesia services provided by a dentist should use procedure code D9223. Any anesthesia services provided by an anesthesiologist (M.D./D.O.) or certified registered nurse anesthetist (CRNA), should use procedure code [...]