Tag - Prior Authorization

Provider Alert!

Provider Alert! Prior Authorization Criteria for Benlysta (J0490)

Date: January 14, 2022 Attention: Oncology Providers Effective Date: March 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: Beginning March 1, 2022, Benlysta (procedure code J0490) will be available for Medicaid members as a medical benefit. Benlysta (belimumab) is indicated to treat active, [...]

Provider Alert!

Provider Alert! Prior Authorization Criteria for Saphnelo (C9086)

Date: January 14, 2022 Attention: Oncology Providers Effective Date: March 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: Beginning March 1, 2022, Saphnelo (procedure code C9086) will be available for Medicaid members as a medical benefit. Saphnelo (anifrolumab-fnia) is indicated to treat moderate [...]

Provider Alert!

Provider Alert! Prior Authorization Criteria for Aduhelm

Date: December 28, 2021 Attention: All Providers Effective Date: January 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: HHSC will add the drug Aduhelm (procedure code J0172) as of Jan. 1, 2022 and implement these criteria for fee-for-service Medicaid on Feb. 1, 2022. Key [...]

Provider Alert!

Provider Alert! Clinical Prior Authorization Criteria Update for Repatha (evolocumab)

Date: December 7, 2021 Attention: Primary Care Providers Effective Date: December 6, 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 Medicaid will update the clinical prior authorization criteria for Repatha (evolocumab) to reflect the recent FDA-approved age expansion. How this impacts providers: Effective December [...]

Provider Alert!

Provider Alert! Promethazine Update

Date: December 7, 2021 Attention: Primary Care Providers Effective Date: December 7, 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 Medicaid revised the Promethazine/Promethazine containing clinical prior authorization criteria by removing the Generic Code Numbers (GCN) for promethazine containing cough and cold products. [...]

Provider Alert!

Provider Alert! Breyanzi available on Medicaid formulary with prior authorization requirements

Date: October 26, 2021 Attention: Oncologists Effective Date: October 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: Prescribers should be aware that Breyanzi (procedure code Q2054) will be available to members through Texas Medicaid pharmacy benefit effective October 1, 2021. Access will require [...]

Provider Alert!

Provider Alert! Alinia (Nitazoxanide) Formulary Change

Date: October 18, 2021 Attention: All Providers Effective date: November 23, 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: The Texas Vendor Drug Program (VDP) will be removing Alinia Suspension and tablet from the list of covered products effective November 23rd 2021. Nitazoxanide tablets [...]

Provider Alert!

Provider Alert! Fetal Magnetic Resonance Imaging (MRI) Requires Prior Authorization

Date: October 11, 2021 Attention: All Providers Effective Dates: June 1, 2021 for code 74712 and April 1, 2021 for code 74713 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: Network providers submitting a prior authorization for fetal Magnetic Resonance Imaging (MRI) should include a [...]

Provider Alert!

Provider Alert! Vision Services-Nonsurgical Benefits to Change

Date: August 25, 2021 Attention: Optometrists and Ophthalmologists Effective Date: September 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: Effective September 1, 2021, Texas Children’s Health Plan(TCHP) will implement the Vision Services benefit changes outlined in the TMHP Bulletin Vision Services-Nonsurgical Benefits to [...]

Provider Alert!

Provider Alert! Sleep Study Prior Authorization Update

Date: August 19, 2021 Attention: Primary Care Providers , Neurologists Effective Date: December 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: Effective December 1, 2021, Texas Children’s Health Plan will require a prior authorization for sleep studies for Members ages over 18 years [...]