Tag - HIPAA

Provider Alert!
14May

Provider Alert! Health Insurance Portability and Accountability Act (HIPAA) Compliant Reasons for Denials and Adjustments

Attention:  All Providers Health Insurance Portability and Accountability Act (HIPAA) Compliant Reasons for Denials and Adjustments   Beginning May 15, 2019, Texas Children’s Health Plan (TCHP) providers will see positive changes to their HIPAA standard 835 electronic remittance and paper explanations of payments (EOPs). TCHP will be providing more robust and HIPAA compliant messages by utilizing national standard claim adjustment reason codes (CARCs) and remittance advice remark codes (RARCs). What are CARCs and RARCs? CARCs and RARCs are industry standard code sets used to explain...

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01Oct

Authorization and Verification Process Updates

Texas Children’s Health Plan has made updates to the authorization process. Individual Member Fax Requests To ensure Health Insurance Portability and Accountability Act (HIPAA) compliance, providers must send one fax request per member with each fax having its own cover sheet. Requests received with multiple members per fax will be returned to the provider and not processed. Minimum Information Required to Process a Request Providers must use the Texas Standard Prior Authorization Request Form*, which can be found at https://www.texaschildrenshealthplan.org/for-providers. Click on Downloadable Forms...

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Provider Alert!
24Apr

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 receive...

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