Prior Authorization – The Checkup

22 Nov

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

Date: November 21, 2022 Attention: All Providers Effective Date: October 25, 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: In response to the COVID-19 Disaster Declaration and in accordance with Texas Health and Human Services Commission, Texas Children’s Health Plan (TCHP) extends the following [...]

By Texas Children's Health Plan Primary Care Providers, OB/GYNs, Office Managers, Specialists, Facilities, Provider Alert Prior Authorization, COVID, COVID-19, waiver 0 Comments Read more...

15 Nov

Provider Alert! CGRP Antagonists- Prophylaxis, Prior Authorization Revision Scheduled for November 22, 2022

Date: November 14, 2022 Attention: Providers Effective Date: November 22, 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) will revise clinical prior authorization (PA) criteria for calcitonin gene-related peptide (CGRP) Antagonists-Prophylaxis. TCHP will separate renewal criteria from the initiation [...]

By Texas Children's Health Plan Primary Care Providers, OB/GYNs, Office Managers, Specialists, Facilities, Provider Alert Prior Authorization, Prophylaxis, Revision, CGRP Antagonists 0 Comments Read more...

07 Nov

Provider Alerts! Prior Authorization Updates

Date: November 7, 2022 Attention: All Providers Effective date: September 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 of updates to the prior authorization lists. How this impacts providers: The updates are [...]

By Texas Children's Health Plan Primary Care Providers, OB/GYNs, Office Managers, Specialists, Provider Alert Prior Authorization, Case Management, targeted case management, prior authorization updates, mental health rehabilitation 0 Comments Read more...

26 Oct

Provider Alert! Clinical Criteria Update for Orkambi Effective November 9

Date: October 25, 2022 Attention: Providers Effective Date: October 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 Health Plan (TCHP) will revise clinical prior authorization criteria for Orkambi (lumacaftor/ivacaftor) to comply with the recent Food and Drug Administration-approved age indications. How this [...]

By Texas Children's Health Plan Primary Care Providers, OB/GYNs, Office Managers, Specialists, Facilities, Provider Alert Prior Authorization, FDA, cystic fibrosis, orkambi, clinical criteria 0 Comments Read more...

26 Oct

Provider Alerts! Cosentyx Clinical Prior Authorization Criteria Revision Scheduled for November 22

Date: October 25, 2022 Attention: Providers Effective Date: October 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 Health Plan (TCHP) will revise clinical prior authorization criteria for Cosentyx to comply with the recent Food and Drug Administration-approved age indications. How this impacts [...]

By Texas Children's Health Plan Primary Care Providers, OB/GYNs, Office Managers, Specialists, Facilities, Provider Alert Prior Authorization, Navitus, cosentyx, psoriasis, arthritis, psoriatic arthritis 0 Comments Read more...

18 Oct

Provider Alert! RSV Fall/Winter Traditional Season Regional Changes Begin October 17

Date: October 17, 2022 Attention: All Providers Effective Date: October 17, 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: Traditional Respiratory Syncytial Virus (RSV) season is here. Texas Children’s Health Plan (TCHP) would like to let providers know that effective October 17, 2022, [...]

By Texas Children's Health Plan Primary Care Providers, OB/GYNs, Office Managers, Specialists, Provider Alert RSV, Prior Authorization, Pharmacy, Benefits, Respiratory Syncytial Virus, refill 0 Comments Read more...

12 Oct

Provider Alert! PDL Prior Authorization Criteria Revisions Scheduled for October 11

Date: October 11, 2022 Attention: All Providers Effective Date: October 11, 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 October 11, 2022, Texas Children's Health Plan (TCHP) will revise the preferred drug list (PDL) prior authorization criteria guide for the Bronchodilators, Beta [...]

By Texas Children's Health Plan Primary Care Providers, OB/GYNs, Office Managers, Specialists, Facilities, Provider Alert Prior Authorization, PDL, Bronchodialators, Beta Agonists, Glucagon Agents 0 Comments Read more...

06 Oct

Provider Alert! Clinical Prior Authorization Criteria Revisions Implement for Medicaid Fee-for-Service on October 26

Date: October 5, 2022 Attention: All Providers Subject: Effective Date: October 26, 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 Health Plan (TCHP) will revise the clinical prior authorization criteria for the Anxiolytics and Sedative/Hypnotics (ASH), Attention Deficit Disorder/Attention-Deficit Hyperactivity Disorder (ADD/ADHD), and Qelbree (also within [...]

By Texas Children's Health Plan Primary Care Providers, OB/GYNs, Office Managers, Specialists, Facilities, Provider Alert, Events ADHD, Prior Authorization, add, Medicaid Fee For Service, Anxiolytics, Sedative, Hypnotic 0 Comments Read more...

03 Oct

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

Date: October 3, 2022 Attention: All Providers Effective Date: September 26, 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 October 31, 2022. This COVID-19 Disaster Declaration extension does NOT apply to 90-day authorizations. As of January 1, 2021, 90-day [...]

By Texas Children's Health Plan Primary Care Providers, OB/GYNs, Office Managers, Specialists, Provider Alert Utilization Management, Prior Authorization, COVID, COVID-19, disaster declaration, adjustment 0 Comments Read more...

26 Sep

Provider Alert! Drug Regimen Optimization Edit Removed After September 12

Date: September 20, 2022 Attention: All Providers Effective Date: September 12, 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: Beginning September 12, 2022, Texas Children's Health Plan (TCHP) will remove the Drug Regimen Optimization prior authorization for all drugs except ADHD drugs. The [...]

By Texas Children's Health Plan Primary Care Providers, OB/GYNs, Office Managers, Specialists, Facilities, Provider Alert ADHD, Prior Authorization, add, drug, Drug Regimen, Optimization 0 Comments Read more...

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