Tag - hhsc

Provider Alert!

Provider Alert! Age and Diagnosis Restriction Updates for Drug Procedure Codes, Effective March 1

Date: April 6, 2022 Attention: Providers Effective Date: March 1, 2022 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: On March 1, 2022, HHSC updated age and diagnosis restrictions for drug procedure codes J0596, J0598, J0599, and J9348 for Medicaid and CHIP. Fee-for-service criteria for [...]

Provider Alert!

Provider Alert! External Medical Review Provider Training now available

Date: April 5, 2022 Attention: All Providers Effective date: February 28, 2022 Call to action: TCHP would like to inform providers of training on External Medical Review (EMR) available from the Health and Human Services Commission. The purpose of this training is to provide an overview to providers on the role/responsibilities for participants involved in an EMR following receipt of an Adverse Benefit Determination from a MCO or dental contractor. TCHP follows the guidance on (EMR) in accordance with the Uniform Managed [...]

Provider Alert!

Provider Alert! Provider enrollment revalidation extension has ended

Date: March 29, 2022 Attention: All providers Effective Date: March 29, 2022 The extension for revalidation due dates for currently enrolled providers ended on February 28, 2022 as announced by the Health and Human Services Commission (HHSC). TCHP COVID-19 Utilization Management Procedure and 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 [...]

Provider Alert!

Provider Alert! Removal of Specialist Requirement from Clinical Prior Authorization Criteria

Date: January 28, 2022 Attention: Providers Effective Date: January 3, 2022 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: Effective January 3, 2022, HHSC removed the specialist requirement from the following clinical prior authorization criteria: CGRP Antagonist, Acute CGRP Antagonists, Chronic Emflaza Ophthalmic Immunomodulators Palforzia Transthyretin Agents VMAT2 Inhibitors Wakix Xyrem/Xywav Zelboraf How this impacts providers: [...]

Provider Alert!

Provider Alert! Respiratory Syncytial Virus (RSV) Season Ends February 1st

Date: January 28, 2022 Attention: Primary care providers Effective Date: February 1, 2022 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: HHSC will close the respiratory syncytial virus (RSV) season in all regions on February 1st, 2022. The 2021-22 traditional RSV season began on October 1, [...]

Provider Alert! Merck Oral COVID-19 drug, Molnupiravir, Added to Formulary

Date: January 24, 2022 Attention: Primary care providers Effective Date: January 3, 2022 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: HHSC added Molnupiravir to the Medicaid and Children’s Health Insurance Program (CHIP) formulary as a payable pharmacy benefit on January 3rd, 2021. Molnupiravir is [...]

Provider Alert!

Provider Alert! HHSC Interoperability and Health Information Exchange Survey for Behavioral Health Providers Open

Date: January 25, 2022 Attention: Behavioral Health Providers Survey will be available: January 24, 2022 thru February 18, 2022 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: The intent of this survey is to gather information on the interoperability needs and technology readiness of behavioral [...]

Provider Alert!

Provider Alert! Revised EVV Policy Handbook Now Available

Date: November 15, 2021 Attention: Financial Management Services Agencies (FMSA) and Consumer Directed Services (CDS) Employers Effective Date: November 1, 2021 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: Revisions to the Electronic Visit Verification Policy Handbook published Nov. 1. The handbook includes EVV standards [...]

Provider Alert!

Provider Alert! EVV Service Bill Codes Table Version 9.6 (STAR Health Updates) Published

Date: November 2, 2021 Attention: Financial Management Service Agencies (FMSAs) Effective Date: November 1, 2021 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: The EVV Service Bill Codes Table provides current billing codes and details for EVV-relevant services in Long-Term Care, Acute Care and Managed [...]

Provider Alert!

Provider Alert! Misuse of EVV Reason Codes Requirements Removed

Date: October 1, 2021 Attention: Financial Management Services Agencies and Consumer Directed Services employers Effective Date: September 1, 2021 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: The Health and Human Services Commission (HHSC) removed the Misuse of EVV Reason Codes Requirements from the EVV [...]