Prior Authorization – The Checkup

27 Aug

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 [...]

By Texas Children's Health Plan Specialists, Provider Alert provider alert, Prior Authorization, optometry, ophthalmologist, vision services 0 Comments Read more...

27 Aug

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 [...]

By Texas Children's Health Plan Primary Care Providers, Specialists, Provider Alert Prior Authorization, neurology, neuro, sleep study 0 Comments Read more...

03 Aug

Provider Alert! Therapy Prior Authorization Update

Date: July 29, 2021 Attention: All Providers Effective Date: August 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) would like to inform providers of updated TCHP prior authorization requirements for therapy services. How this impacts providers: Requests for acute [...]

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

27 Jul

Provider Alert! Prior authorization Updates

Date: July 23, 2021 Attention: All Providers Effective Dates: August 1, 2021 and November 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: Services no longer requiring a prior authorization effective August 1, 2021 include the following: Biofeedback Codes 90901, 90912, and 90913 Durable Medical Equipment [...]

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

13 Jul

Provider Alert! Trikafta Age Expansion in Cystic Fibrosis Agents Clinical Prior Authorization Begins September 1

Date: July 8, 2021 Attention: Primary Care Providers and Pulmonologists 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: Texas Children’s Health Plan will update the clinical prior authorization criteria for Trikafta (elexacaftor, tezacaftor, ivacaftor) to align with the FDA recent [...]

By Texas Children's Health Plan Primary Care Providers, Specialists, Provider Alert Prior Authorization, pulmonology, Pulmonologist, trikafta 0 Comments Read more...

23 Jun

Provider Alert! Speech, Physical, and Occupational Therapy Prior Authorization Update

Date: June 23, 2021 Attention: Therapy and Primary Care Providers Effective Date: June 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: Texas Children’s Health Plan (TCHP) would like to inform providers of updated TCHP prior authorization requirements. How this impacts providers: Effective June 23, 2021, [...]

By Texas Children's Health Plan Primary Care Providers, Specialists, Provider Alert provider alert, Prior Authorization, occupational therapy, Therapy, speech, physicial therapy 0 Comments Read more...

22 Jun

Provider Alert! Reminder: Targeted Case Management Code T1017 Requires Prior Authorization

Date: June 22, 2021 Attention: Primary Care Providers and Behavioral Health 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: As a reminder, Texas Children’s Health Plan (TCHP) requires a prior authorization for Targeted Case Management, Code T1017. How this impacts providers: Standard Prior Authorization [...]

By Texas Children's Health Plan Primary Care Providers, Specialists, Provider Alert provider alert, Prior Authorization, Case Management 0 Comments Read more...

24 May

Provider Alert! Clinical Prior Authorization Updates for Enzymes

Date: May 20, 2021 Attention: Geneticists, Hematologists, and Oncologists Effective Date: June 30, 2021 Call to action: Effective June 30, 2021, the Texas Health and Human Services Commission (HHSC) will update the enzymes prior authorization criteria to reflect recent FDA-approved administration changes. This impacts the following agents: Adagen (pegademase bovine), Ceprotin (protein C concentrate), Fabrazyme (agalsidase beta), and Revcovi (elapegademase). Adagen (J2504 procedure code) has been discontinued by the manufacturer. Ceprotin 400-600 units vial is no longer available through retail pharmacy benefits. The Ceprotin 400-600 [...]

By Texas Children's Health Plan Specialists, Provider Alert provider alert, provider alerts, Prior Authorization, clinical prior authorization 0 Comments Read more...

23 Apr

Provider Alert! Peer to Peer Provider Authorization Communication

Date: April 23, 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 make providers aware of the standard procedures when they receive a peer to peer letter for a denial or a partial [...]

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

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...

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