Prior Authorization – The Checkup

20 Apr

Provider Alert! Prior Authorization Update for Continuous Glucose Monitoring

Date: April 20, 2021 Attention: All Providers Effective Date: April 20, 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 would like to inform network providers that short-term continuous glucose monitoring service Procedure Codes 95250 and 95251 will require prior authorization [...]

By Texas Children's Health Plan Primary Care Providers, OB/GYNs, Office Managers, Specialists, Facilities, Provider Alert provider alerts, Prior Authorization, diabetes, Glucose Monitor 0 Comments Read more...

14 Apr

Provider Alert! Online Authorization Platform is Able to Accept Additional Clinical Information

Date: April 8, 2021 Attention: All Providers 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 that utilize our online authorization platform; Health Trio that this platform is now accepting additional clinical information once [...]

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

13 Apr

Provider Alert! Reminders: Prior Authorization Requirements and Qualifications for Urgent Requests

Date: April 12, 2021 Attention: All Providers 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 remind network providers of the prior authorization requirements and qualifications for urgent requests. How this impacts providers: The Utilization Management Department requires [...]

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

01 Apr

Provider Alert! Prior Authorization Criteria for Zolgensma Updated

Date: March 31, 2021 Attention: Neurologists and SMA specialists Effective Date: March 31, 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 of an update to prior authorization criteria for Zolgensma (onasemnogene abeparvovec) drug HCPCS code J3399. Zolgensma is indicated for treatment of [...]

By Texas Children's Health Plan Specialists provider alert, provider alerts, Prior Authorization, neurology, Zolgensma, mutation, SMA 0 Comments Read more...

30 Mar

Provider Alert! Genetic Testing Prior Authorization Requirement Reminder

Date: March 26, 2021 Attention: All Providers 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 remind network providers that all genetic testing requires an approved prior authorization before the laboratory tests can be completed. Quest Diagnostics [...]

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

26 Mar

Provider Alert! Clinical Prior Authorization Updates for Epidiolex

table { border-collapse: collapse; }tr,td { border: solid thin; } Date: March 26, 2021 Attention: Neurologists Effective Date: May 11, 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 May 11, 2021, the Texas Health and Human Services Commission (HHSC) will update the ICD-10 [...]

By tcph Specialists, Provider Alert Prior Authorization, Epidiolex 0 Comments Read more...

25 Mar

Provider Alert! Clinical Prior Authorization Updates for Cytokine and CAM Antagonist Agents

table { border-collapse: collapse; }tr,td { border: solid thin; } Date: March 25, 2021 Attention: Gastroenterologists, Rheumatologists Effective Date: May 4, 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 May 4, 2021, the Texas Health and Human Services Commission (HHSC) will update the [...]

By tcph Specialists, Provider Alert Prior Authorization, cytokin, CAM 0 Comments Read more...

16 Mar

Provider Alert! Prior Authorization Requirements for Incontinence Supplies

Date: March 15, 2021 Attention: All Providers Effective Date: December 22, 2020 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 the prior authorization requirements for incontinence supplies. How this impacts providers: Incontinence supplies (diapers, wipes, and under pads) may be considered for members age [...]

By tcph Primary Care Providers, OB/GYNs, Office Managers, Specialists, Provider Alert Prior Authorization, incontinence 0 Comments Read more...

01 Mar

Provider Alert! Healthcare Common Procedure Coding System (HCPCS) update for Code 99201

Date: January 21, 2021 Attention: All Providers Effective Date: January 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) aligns with the guidance from Texas Medicaid Healthcare Partnership (TMHP) regarding HCPCS Code 99201. This code has been discontinued as [...]

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

01 Mar

Provider Alert! Clinical Prior Authorization Updates for Cystic Fibrosis Agents

Date: February 25, 2021 Attention: Pulmonologists Effective Date: April 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: Effective April 6, 2021, the Texas Health and Human Services Commission (HHSC) will update the cystic fibrosis (CF) agents prior authorization criteria to reflect recent FDA-approved [...]

By Texas Children's Health Plan Specialists, Provider Alert Prior Authorization, pulmonology, Pulmonologist, cystic fibrosis, CFTR 0 Comments Read more...

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