medicaid – Page 2 – The Checkup

21JulJuly 21, 2023

Provider Alert! Medicaid Preferred Drug List and Formulary Changes

Date: July 21, 2023 Attention: All Providers Effective Date: July 27, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective July 27, 2023, select medication(s) moved from “preferred” to “non-preferred” status. A summary of the changes is included below. Resource: https://www.txvendordrug.com/formulary/preferred-drugs Changes with biggest impact to Texas Children Health Plan members and providers: The drugs listed below were either not previously reviewed (NR) and became non-preferred (NPD) or previously considered a preferred agent (PDL) but now have changed...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialistsformulary changes, medicaid, PDL, Preferred Drug List0 CommentsRead more...

19JulJuly 19, 2023

Provider Alert! Zynteglo® now a Medicaid and CHIP Benefit – Prior Authorization Effective September 1, 2023

Date: July 18, 2023 Attention: All Providers Effective Date: September 1, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective September 1, 2023, the Texas Health and Human Services (HHSC) will be implementing required prior authorization criteria for Zynteglo® (procedure code J3590) for Medicaid and CHIP. Zynteglo® became a benefit of Medicaid and CHIP on July 1, 2023. Zynteglo® (betibeglogene autotemcel) is an autologous stem cell-based gene-therapy indicated for treating adult and pediatric patients with...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, SpecialistsCHIP, gene therapy, medicaid, Prior Authorization, Zynteglo0 CommentsRead more...

13JulJuly 13, 2023

Provider Alert! No-cost sports and school physicals for CHIP and Medicaid patients

Date: July 13, 2023 Attention: Primary Care Providers, OB/GYNs, and Office Managers Call to action: It will soon be back-to-school season, which means your patients will need to complete their annual sports and school physicals. As part of the Healthy Rewards Program*, Texas Children’s’ Health Plan CHIP, STAR and STAR Kids members ages 5 to 19 years** can receive a no-cost sports and school physical. A Texas Health Steps or well-child visit within the last 12 months is required. Members should bring...

By Texas Children's Health PlanOB/GYNs, Office Managers, Primary Care Providers, Provider AlertCHIP, medicaid, School Physicals0 CommentsRead more...

13JulJuly 13, 2023

Provider Alert! Signature Updates to Home Health Prior Authorization Request Forms

Date: July 12, 2023 Attention: All Providers Effective date: July 1, 2023 Call to action: The purpose of this communication is to provide awareness that the signature requirements for Title XIX (Medicaid) Home Health Services have changed. Medicaid-enrolled physicians and allowed practitioners can now sign prior authorizations and order covered Medicaid Home Health Services, including skilled nursing, home health aide services, durable medical equipment and supplies, and adult physical and occupational therapy services. An allowed practitioner is a physician assistant (PA) or an advanced...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, SpecialistsHome Health Services, medicaid, Medicaid Services, Prior Authorization0 CommentsRead more...

29JunJune 29, 2023

Provider Alert! Case Management for Children and Pregnant Women (CPW) Carve-In Reminder

Date: June 29, 2023 Attention: All Providers Call to action: The purpose of this communication is to remind providers of the Case Management for Children & Pregnant Women (CPW) carve-in to Medicaid that became effective September 1, 2022. Background: House Bill 133, 87th Legislature, Regular Session, 2021, requires the case management for children and pregnant women benefit to be carved-in to Medicaid managed care, which means Medicaid managed care organizations like Texas Children’s Health Plan (TCHP) will contract with and reimburse providers...

By Texas Children's Health PlanProvider Alertmedicaid, provider alert0 CommentsRead more...

14JunJune 14, 2023

Provider Alert! FMSA Cost Survey

Date: June 13, 2023 Attention: Financial Management Services Agencies (FMSA) Due date: August 31, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to make FMSAs aware of a cost survey with a due date of August 31, 2023. Background information: The purpose of the cost survey is to collect FMSA costs for the state fiscal year 2022 for all FMSAs in Texas. This cost information will be referenced in the review of current FMSA rates for Medicaid and Non-Medicaid programs. Health and Human Services...

By Texas Children's Health PlanOffice Managers, Provider Alertcost, FMSA, medicaid, rates, Survey0 CommentsRead more...

25JanJanuary 25, 2023

Provider Alert! Continuous Glucose Monitor and Integrated Insulin Pump Equipment Change for Texas Medicaid

Date: January 25, 2023 Attention: Primary Care Providers, Endocrinologists, and Diabetes Educators Effective date: January 1, 2023 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: Texas Children’s Health Plan (TCHP) would like to inform providers of new adjunct continuous glucose monitor (CGM) device and supply codes...

By tcphPrimary Care Providers, Provider Alert, SpecialistsCGM, Insulin, medicaid0 CommentsRead more...

08DecDecember 8, 2022

Provider Alert! Update: New Collaborative Care Model Medicaid Benefit; Attestation Form Now Available

Date: December 5, 2022 Attention: All Providers Effective Date for attestation form: January 1, 2023 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated with 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: Texas Children’s Health Plan (TCHP) would like to remind providers that the Health and Human Services Commission (HHSC) has drafted a new Medicaid...

By Texas Children's Health PlanOB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialistsbenefit, CoCM, collaborative care, CPT Codes, medicaid, procedure code0 CommentsRead more...

27OctOctober 27, 2022

Provider Alert! Change to Signature Requirements for Title XIX (Medicaid) Home Health Services

Date: October 27, 2022 Attention: Home Health Providers Effective date: September 21, 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 purpose of this communication is to inform providers that the Health and Human Services Commission (HHSC) has recently adopted rules in alignment...

By Texas Children's Health PlanProvider Alert, SpecialistsHome Health, Home Health Providers, medicaid, Medicaid Home Health Services, Skilled Nursing, Title XIX0 CommentsRead more...

12AugAugust 12, 2022

Provider Alert! Benefit Criteria to Change for Vaccine Services

Date: August 11, 2022 Attention: All Providers Effective date: September 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: The purpose of this communication is to inform providers that the Health and Human Services Commission (HHSC) has completed a comprehensive review of vaccine-related services...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, SpecialistsBenefit Changes, medicaid, policy, vaccine0 CommentsRead more...

Tag - medicaid