Prior Authorization – The Checkup

02 Jul

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 [...]

05 May

Prior Authorization Reference Information

The Texas Children’s Health Plan website now has an additional resource for information related to prior authorization requirements. The Prior Authorization Reference Information documents the codes that require authorization for payment based on authorization category. This list is not yet all-inclusive. It can be found at: https://www.texaschildrenshealthplan.org/sites/default/files/pdf/PA%20Code%20List%20December%202018.pdf In addition, providers can submit an authorization request online for the codes listed on the Prior Authorization Reference Information document via Clear Coverage. For access to or training on the use of Clear [...]

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24 Apr

Prior Authorization Reference Information

By Texas Children's Health Plan Primary Care Providers, OB/GYNs, Office Managers, Specialists, Provider Alert Prior Authorizations, Prior Authorization, Clear Coverage 0 Comments Read more...

02 Mar

Provider Alert! Prior Authorization

Prior authorization alert Effective January 1, 2019, Texas Children’s Health Plan updated the prior authorization listing. Please note there are some key changes for providers. Removed from the list and will no longer require prior authorization: Baclofen Pump New to the list: Home Telemonitoring Updates: Ambulance (non-emergent transport) has been updated to Non-Emergency Ambulance Transport. Augmentative Communication Device has been updated to Augmentative Communication Device and Accessories. Chemotherapy non-FDA approved has been updated to Non-FDA approved medications. Cranial Molding Orthosis (Helmets) has been updated to Cranial Molding Orthosis. High cost (>$50,000) [...]

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01 Feb

Provider Alert! Prior Authorization Alert

Effective January 1, 2019, Texas Children’s Health Plan updated the prior authorization listing. Please note there are some key changes for providers. Removed from the list and will no longer require prior authorization: Baclofen Pump New to the list: Home Telemonitoring Updates: Ambulance (non-emergent transport) has been updated to Non-Emergency Ambulance Transport. Augmentative Communication Device has been updated to Augmentative Communication Device and Accessories. Chemotherapy non-FDA approved has been updated to Non-FDA approved medications. Cranial Molding Orthosis (Helmets) has been updated to Cranial Molding Orthosis. High cost (>$50,000) injectable in [...]

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02 Jan

Provider Alert! TCHP Prior Authorization Requirement

Effective January 1, 2019, TCHP will be updating the prior authorization listing. Please note there are some key changes for providers. Removed from the list and will no longer require prior authorization: Baclofen Pump New to the list: Home Telemonitoring Updates: Ambulance (non-emergent transport) has been updated to Non-Emergency Ambulance Transport. Augmentative Communication Device has been updated to Augmentative Communication Device and Accessories. Chemotherapy non-FDA approved has been updated to Non-FDA approved medications. Cranial Molding Orthosis (Helmets) has been updated to Cranial Molding Orthosis. High cost (>$50,000) injectable in the [...]

By Texas Children's Health Plan Primary Care Providers, OB/GYNs, Office Managers, Specialists, Provider Alert provider alert, Prior Authorization, Authorizations 0 Comments Read more...

19 Dec

Nutritional supplement guideline change

Effective 10/1/2018, Texas Children’s Health Plan will no longer require prior authorization for nutritional products for members 20 years and younger who: receive all or part of their nutritional intake through a tube as documented by ICD-10 codes (z43.1; z93.1, z93.4), OR have a metabolic disorder that has been documented with one of the diagnosis codes listed in the current TMPPM Section 2.2.17.2.2. Providers will retain the responsibility of maintaining appropriate documentation for the nutritional products supplied. A retrospective review may be [...]

By Texas Children's Health Plan Primary Care Providers, Specialists Prior Authorization, Guidelines, Nutrition, Nutritional Supplements, Diet, Formula 0 Comments Read more...

02 Oct

Provider Alert! Nutritional Supplement Guideline Change

By Texas Children's Health Plan Primary Care Providers, Office Managers, Specialists, Provider Alert Prior Authorization, Nutritional Supplements 0 Comments Read more...

03 Sep

Key Changes to TCHP Therapy Authorization Guidelines

When services were not prior authorized by Texas Children’s Health Plan, (through another MCO or TMHP) the authorization request must include: A copy of the previously approved authorization letter. All of the documentation that was sent in the original authorization request to the previous MCO or TMHP, including any physician orders that were used to determine the start of care. If the services requested do not meet TCHP criteria, the services will be honored for the shorter of 90 days or until [...]

By Texas Children's Health Plan Primary Care Providers, Office Managers, Specialists Prior Authorization, Guidelines, Authorizations, Authorization, Therapy 0 Comments Read more...

20 Aug

Upcoming Changes to Prior Authorization for Antipsychotic Medications

Effective September 1, 2018, the prior authorization for antipsychotic medications will change. At the May 15th Texas Association of Community Health Plans P&T Committee meeting, the Texas Managed Care Organizations, supported by Navitus, voted by majority to modify the Antipsychotic Clinical Prior Authorization Edit in compliance with the guidelines set forth by the Health and Human Services Commission Vendor Drug Program. The health plans opted to remove the requirements for diagnoses, while maintaining criteria for age and duplicate therapy [...]

By Texas Children's Health Plan Primary Care Providers, OB/GYNs, Office Managers, Specialists Vendor Drug Program, Prior Authorization, Navitus, Antipsychotic Clinical Prior Authorization Edit 0 Comments Read more...

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