Tag - Prior Authorization Requirements

Provider Alert!
09Oct

Provider Alert! Prior Authorization Requirements will be Changing in January 2024

Date: October 6, 2023 Attention: All Providers Effective date: January 2, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that there will be changes to the prior authorization requirements that become effective on January 2, 2024. Click here to view the requirements. Another resource, Prior Authorization Reference Information, is a searchable Prior Authorization list linked to the code tables for each benefit category and accessible here. How this impacts providers: The medical services listed on the Prior Authorization...

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Provider Alert!
19Nov

Provider Alert! Updates to Prior Authorization Requirements for Genetic Testing, Wheelchair accessory, and Personal Care Services

Attention: All providers Effective Date: March 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: Texas Children’s Health Plan (TCHP) would like to inform network providers of services that require a prior authorization effective March 1, 2021. Genetic Testing Codes: 81202 APC (adenomatous polyposis coli) (eg,...

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Provider Alert!
12Sep

Provider Alert! Update: Prior Authorization Requirements

Please note the following key prior authorization requirement changes for providers. Updates: Effective July 1, 2019 Psychological testing (procedure codes 96130, 96131, 96136, and 96137), neurobehavioral testing (procedure codes 96116 and 96121), and neuropsychological testing (procedure codes 96132, 96133, 96136, and 96137) are limited to four hours per member, per day and eight hours per member, per calendar year. Prior Authorization will not be required when billed within these limits. Additional hours require prior authorization. Botulinum toxin injections will only require authorization when...

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Provider Alert!
02Jul

Provider Alert! TCHP Prior Authorization Requirements

Date:  July 1, 2019 Subject: TCHP Prior Authorization Requirements Effective October 1, 2019, TCHP has updated the prior authorization listing. Please note there are some key changes for providers.   Added:            Case by Case Added Services This category includes CPT/HCPCS codes that are listed as not payable in the TMHP fee schedule. Clinician Administered Drugs that Require Authorization Please refer to the Prior Authorization Reference Information document for specific codes that fall under this category. This document can be found at: https://www.texaschildrenshealthplan.org/for-providers/provider-resources   DME Repair (K0739)...

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