Tag - Fax Blast

Provider Alert! CHIP Member Eligibility Now Available via EDI HIPAA 270/271 Transaction

Attention:  CHIP Providers and Submitters RE: CHIP Member Eligibility Now Available via EDI HIPAA X12 270/271 Transaction Note: This applies only to CHIP providers and submitters. No action is required for Medicaid providers or submitters. Available immediately, CHIP providers and submitters wishing to request and receive CHIP member eligibility using HIPAA X12 270/271 transactions may begin utilizing a new eligibility system. CHIP providers and Electronic Data Interchange (EDI) submitters may begin the Trading Partner Testing process by contacting TMHP at EDI.Eligibility@tmhp.com to [...]

Provider Alert! Therapy Modifiers

Therapy modifiers A modifier must be used to indicate when treatment services have been rendered by a licensed therapist/ physician or a therapy assistant under supervision of a licensed therapist. The following modifiers are not required for evaluation or re-evaluation codes because those services may not be rendered by therapy assistants. UB – Services delivered by a licensed therapy assistant under supervision of a licensed therapist. U5 – Services delivered by a licensed therapist or physician. Claims for co-treatment services must be submitted with [...]

Provider Alert! Therapy Wait List

Subject:  Therapy Providers Effective 1/15/2018, HHSC formally required MCOs to report on access issues specific to all therapy modalities (PT, OT, ST). In the future, if Texas Children’s Health Plan (TCHP) should receive a member complaint specific to access to care, TCHP will follow-up with each therapy provider. If a wait list is identified, each provider will be required to submit detailed information for each member waiting for care. The information will need to be populated in a specified template, [...]

Provider Alert! Uniform Hospital Rate Increase Program (UHRIP)

Attn: STAR HOSPITAL SERVICES RE: Uniform Hospital Rate Increase Program (UHRIP) Dear Provider, The Texas Health and Human Services Commission (HHSC) has received approval from the Centers for Medicare and Medicaid Services to implement the Uniform Hospital Rate Increase Program (UHRIP) for hospital services effective March 1, 2018 for Harris and Jefferson Service Delivery Areas (SDAs).  State-owned hospitals and institutions for mental diseases are excluded from the program. Texas Children’s Health Plan (TCHP) will be sending a Letter of Agreement to all eligible [...]

Provider Alert! Changes to physical, occupational and speech therapy benefits for all ages

Effective for dates of service on or after September 1, 2017, physical therapy (PT), occupational therapy (OT) and speech therapy (ST) benefits for all ages will change for Texas Medicaid. Please visit the TMHP website to review for changes to this medical benefit policy that applies to the following: Billing structure changes for PT, OT and ST services Procedure codes end-dating August 31, 2017 Required modifiers Claims filing changes Clarification to benefits Providers may refer to the current Texas Medicaid Provider Procedures Manual, Physical Therapy, Occupational [...]

Provider Alert! Benefit Changes Prior Authorization Update

Attention: All Texas Children’s Health Plan Providers Subject: UPDATE to Changes for Physical, Occupational, and Speech Therapy Benefits   Prior Authorization Changes Update Changes to TCHP Prior Authorizations for PT, OT, and ST services: For therapy authorizations with approved dates of service spanning the 9/1 transition date, TCHP created a revised authorization in our system that reflects the new billing structure using the same authorization number. For all therapy requests that were submitted prior to 9/1, the revised authorization will start on 9/1 and cover through the end [...]

Provider Alert! Changes to Physical, Occupational, and Speech Therapy Benefits for All Ages

Subject: Changes to Physical, Occupational, and Speech Therapy Benefits for All Ages Effective for dates of service on or after September 1, 2017, physical therapy (PT), occupational therapy (OT), and speech therapy (ST) benefits for all ages will change for Texas Medicaid. Please review http://www.tmhp.com/News_Items/2017/06-June/06-30- 17%20Physical,%20Occupational,%20and%20Speech%20Therapy%20Benefits%20for%20All%20Ages%20 to%20Change%20for%20Texas%20Medicai.pdf for changes to this medical benefit policy that applies to the following: Billing structure changes for PT, OT, and ST services Procedure codes end-dating August 31, 2017 Required modifiers Claims filing changes Clarification to benefits Providers may refer to the current Texas Medicaid [...]

Provider Alert! Screening for Maternal Depression – Essential to Child Well-Being

Effective January 1, 2017, Texas Children’s Health Plan will reimburse providers for maternal depression screening conducted at a well-child visit. Postpartum depression screening utilizing the Edinburgh Postnatal Depression Scale may be reimbursed up to 2 times per member ages 0-6 months, using CPT code 96161. Code 96161 is used to report the use of a standardized instrument to screen for health risks in the caregiver for the benefit of the patient. The reimbursement for this code will be based [...]