Tag - OB

OB/GYN appointment availability standards

What are appointment availability standards? How do you as a provider with Texas Children’s Health Plan play a role? In 2015 Senate Bill 760 passed, requiring Texas Health and Human Services Commission (HHSC) to monitor the provider networks of managed care organizations. Texas Children’s Health Plan would like to ensure members are able to schedule appointments with providers in accordance with the HHSC’s appointment accessibility guidelines.                   **Texas Children’s Health Plan periodically surveys each participating provider to ensure that members are able [...]

Best practices to boost postpartum appointments

RELATE DISCUSS the importance of the postpartum visit with your patient during her pregnancy DISTRIBUTE the Texas Children’s Health Plan Postpartum Checklist to your patients in the late third trimester MOTIVATE INCLUDE Texas Children’s Health Plan postpartum visit information in your practice welcome packet INFORM your patients about the Texas Children’s Health Plan value-added service they qualify for by attending their postpartum visit TRACK your appointment success rate (the percentage of your patients who get the postpartum check between 21-56 days) SET A DATE SCHEDULE the postpartum [...]

Be a HEDIS HERO for your pregnant patients

The National Committee for Quality Assurance (NCQA) is a non-profit organization that measures the quality of healthcare across large populations. NCQA does this through its Health Effectiveness and Data Set, also known as HEDIS. HEDIS ‘Measures’ are a set of evidence based standards that Texas Children’s Health Plan is committed to improving upon in order to provide the best care for our members. Making changes across your patient population is easier than you think! In fact, you can become a [...]

A suitable timeline for prenatal and postpartum care

Timely prenatal and postpartum care is an important component of successful health outcomes for women and their babies, as well as a measure of quality care. Prenatal visit The first prenatal visit must be rendered in the first trimester or during the first 42 days of enrollment into the health plan to meet the standards set forth by Healthcare Effectiveness Data and Information Set (HEDIS). Postpartum visit In order for the visit to qualify as a postpartum visit, it must include documentation in [...]

Texas Becomes 4th State to Launch Universal Baby Box University Program to Equip New Parents to give their Babies a Healthy Start in Life

Encourage your patients to be a part of the Baby Box movement, which promotes safe sleep for infants! Texas has become the 4th state to launch Baby Box University, which helps new parents give their babies a healthy start in life. The Baby Box program is designed to encourage mothers to get prenatal care and promote a good relationship between moms-to-be and their doctors. By completing an online syllabus through the company’s educational platform, Baby Box University, all new and [...]

The Texas Clinician’s Postpartum Depression Toolkit

A new resource for screening, diagnosis and treatment of postpartum depression. Click here to view this helpful resource for postpartum depression: http://www.texaschildrenshealthplan.org/sites/default/files/pdf/the_texas_clinicians_postpartum_depression_toolkit%20FINAL.pdf

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 [...]

Changes to the Sterilization Consent Form and Instructions, Approval Process, and Denial Letter

Changes to the Sterilization Consent Form and Instructions, Approval Process, and Denial Letter Information posted July 15, 2016 Note: This article applies to transactions submitted to TMHP for processing. For transactions processed by a Medicaid managed care organization (MCO), providers must refer to the MCO for information about benefits, limitations, prior authorization, and reimbursement. Effective September 1, 2016, the following changes will be made to the Sterilization Consent Form and corresponding instructions, the Sterilization Consent Form Denial Letter, and the process that [...]

Cesarean Delivery

This article presents new research and strategies to safely reduce the rate of primary Cesarean delivery. One out of three deliveries is by Cesarean.  In certain situations, Cesarean can be life-saving for both mother and baby.  But Cesarean deliveries aslo carry greater risks for mothers—research has shown that women who deliver their first baby by cesarean are more likely to need blood transfusions and be admitted to the ICU than women who have a vaginal delivery.  In addition, after that [...]