Tag - pre-authorization

Provider Alert!
21Sep

Provider Alert! Update: Substance Use Disorder (SUD) Service Code H0050 now requires a Prior Authorization and Authorization Reminders

Attention: Behavioral Health Providers    Effective Date: September 23, 2020 for Code H0050 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) aligns with the prior authorization criteria available in the most recent Texas Medicaid Provider Procedures Manual (TMPPM), Withdrawal Management Services....

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26Mar

5 steps to a Successful Authorization

Know what requires a prior authorization. Go to TexasChildrensHealthPlan.org or Navitus.com to check prior authorization requirements for Medical/Behavioral Health services before providing services or sending prescriptions to the pharmacy. Become familiar with the authorization guidelines. Guidelines are available upon request and on the Texas Children’s Health Plan Provider TouCHPoint portal at TexasChildrensHealthPlan.org/for-providers. Submit requests in advance of the scheduled service. Authorizations for outpatient services can take 3 business days to process. Ensuring that submissions are done in advance will avoid potential claim denials. Be comprehensive in...

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01Sep

Provider Alert! Preventing Pre-Term Pregnancies

To: All Providers Subject: Effective September 1, 2015 all Progesterone therapy will require a pre-authorization from Texas Children’s Health Plan. Claims billed using the branded Makena will no longer require a U1 modifier. Pre-authorized use of Makena (hydroxyprogesterone caproate injection) will need to be submitted as J1725 with the appropriate NDC information as required on all claims. Claims billed using the compounded 17-P therapy will now require the U1 modifier. Pre-authorized use of 17-P will need to be submitted as J1725 with the...

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