Tag - Prior Authorization

Provider Alert!

Provider Alert! Lorazepam Clinical Prior Authorization Update

table { border-collapse: collapse; }tr,td { border: solid thin; } Date: June 21, 2022 Attention: All Providers Effective Date: August 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. TCHP will apply updates and reprocess impacted claims as soon as possible. However, please allow up to sixty (60) [...]

Provider Alert!

Provider Alert! Prior authorization criteria for Voxzogo (Vosoritide)

Date: June 15, 2022 Attention: All Providers Subject: Prior authorization criteria for Voxzogo (Vosoritide) Effective Date: July 15, 2022 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: Effective July 15, 2022, Texas Children’s Health Plan (TCHP) will implement the Voxzogo clinical edit in-line with the Health [...]

Provider Alert!

Provider Alert! Prior Authorization Criteria Update for Aduhelm Begins July 1

Date: June 15, 2022 Attention: All Providers Subject: Prior Authorization Criteria Update for Aduhelm Begins July 1 Effective Date: July 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: Texas Children’s Health Plan (TCHP) would like to inform providers that the Health and Human Services [...]

Provider Alert!

Provider Alert! Prior Authorization Criteria Updates for Yescarta and Tecartus

Date: June 1, 2022 Attention: All Providers Effective Date: July 1, 2022 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 inform providers that the Health and Human Services Commission (HHSC) will update prior authorization criteria for Yescarta [...]

Provider Alert! COVID-19 Disaster Declaration – ALERT #5 – Prior Authorization Adjustments

Date: May 25, 2022 Attention: All Providers Effective Date: May 23, 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. The Prior Authorization Adjustments listed here are extended until June 30, 2022. This COVID-19 Disaster Declaration extension does NOT apply to 90-day authorizations. As of January 1, 2021, 90-day [...]

Provider Alert!

Provider Alert! Push-rim Activated Power Assist Wheelchair (PAPAW) System Procedure Code E0986 to Become a Benefit for Texas Medicaid

Date: May 25, 2022 Attention: All Providers Effective Date: June 1, 2022 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 inform providers that effective for dates of service on or after June 1, 2022, push-rim activated power [...]

Provider Alert!

Provider Alert! Laser Interstitial Thermal Therapy to Require Prior Authorization

Date: April 6, 2022   Attention: Radiologists Effective date: July 5, 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. Regarding system configuration updates, TCHP will apply updates and reprocess impacted claims as soon as possible. However, due to volume, please allow up to sixty (60) business [...]

Provider Alert!

Provider Alert! Updates to Phosphate Binder Prior Authorization Criteria Scheduled for April 5

Date: March 10, 2022 Attention: Primary care providers Effective Date: April 05, 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: On April 5, 2022, HHSC will revise the phosphate binder non-preferred prior authorization criteria by transferring specific criteria to the phosphate binders’ clinical prior authorization. [...]

Provider Alert!

Provider Alert! Oxbryta Prior Authorization Criteria Updates Scheduled for April 5

Date: March 10, 2022 Attention: Primary care providers Effective Date: April 5, 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:  On April 5, 2022, HHSC will revise the prior authorization criteria in the Sickle Cell Disease Agents clinical prior authorization for Oxbryta (voxelotor) to ensure alignment [...]

Provider Alert!

Provider Alert! Prior Authorization Criteria to Change for Omalizumab (Xolair) Effective March 1, 2022

Date: March 3, 2022 Attention: Primary care providers Effective Date: March 01, 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: Effective on March 1, 2022, prior authorization criteria will change for omalizumab (Xolair) procedure code J2357. Prior authorization requests for clients with chronic idiopathic [...]