Prior Authorization – The Checkup

15 Jan

Provider Alert! Essential Information for Prior Authorization Submission

Date: January 13, 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 required information for a prior authorization submission. The Texas Standard Prior Authorization Form* including the following information: Member [...]

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

08 Jan

Provider Alert! Prior Authorization Re-certification Requests Submission for Texas Medicaid

Date: January 7, 2021 Attention: Therapy Providers Effective Date: October 1, 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) aligns with the guidance on prior authorization (PA) recertification requests. In compliance with House Bill 3041 of the 86th Texas [...]

By Texas Children's Health Plan Specialists, Provider Alert Prior Authorization, Therapy, Therapy Providers, Re-certification 0 Comments Read more...

07 Jan

Provider Alert! New prior authorization requirements for Omalizumab (Xolair)

Date: December 23, 2020 Attention: Allergists & Immunologists, Pulmonologists Effective Date: February 1, 2021 Call to action: Texas Children’s Health Plan (TCHP) is aligning prior authorization criteria for omalizumab (Xolair), J2357, with the Texas Medicaid Provider Procedures Manual (TMPPM). Xolair is a clinician administered drug indicated for members with moderate to severe persistent asthma or chronic idiopathic urticaria (CIU) who remain symptomatic despite H1 antihistamine treatment. Below are the new prior authorization criteria for TCHP members effective 2/1/2021. For initial therapy, the [...]

By Texas Children's Health Plan Specialists, Provider Alert Prior Authorization, allergist, Pulmonologist, Allergists 0 Comments Read more...

07 Jan

Provider Alert! New prior authorization requirements for Mepolizumab (Nucala)

Date: December 21, 2020 Attention: Allergists & Immunologists, Pulmonologists Effective Date: February 1, 2021 Call to action: Texas Children’s Health Plan (TCHP) is aligning prior authorization criteria for mepolizumab (Nucala), J2182, with the Texas Medicaid Provider Procedures Manual (TMPPM). Mepolizumab (Nucala) is a clinician administered drug indicated for members with severe asthma with an eospinophilic phenotype. Mepolizumab (Nucala) is also indicated as a steroid sparing agent for certain types of hypereosinophilic syndrome (HES) and eosinophilic granulomatosis with polyangiitis (EGPA). Below are the new [...]

By Texas Children's Health Plan Specialists, Provider Alert Prior Authorization, Corticosteroids, allergist, pulmonology 0 Comments Read more...

22 Dec

Provider Alert! Prior Authorization Requirements Guide

table { border-collapse: collapse; }tr,td { border: solid thin; } Attention: All Providers Effective Date: March 8, 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 network providers of services that require a prior authorization [...]

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

07 Dec

Provider Alert! Reminder of Therapy Benefits and Services Requiring a Prior Authorization

.split3 { column-count: 3; } Attention: Primary Care, Therapy Providers, and Sub-specialties 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 therapy benefits and those services that require a prior authorization. Benefit: Physical therapy and [...]

By tcph Primary Care Providers, Specialists, Provider Alert Prior Authorization, therapy benefits 0 Comments Read more...

30 Nov

Provider Alert! Benefit reminder and Prior Authorization Update for Spravato

Attention: Behavioral health 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 Health and Human Services Commission (HHSC) on the revised prior authorization criteria for Spravato (Esketamine). Effective January 1, 2021, [...]

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

19 Nov

Provider Alert! Updates to Prior Authorization Requirements for Genetic Testing, Wheelchair accessory, and Personal Care Services

Attention: All providers Effective Date: March 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 network providers of services that require a prior authorization effective March 1, 2021. Genetic Testing Codes: 81202 APC (adenomatous polyposis coli) [...]

By tcph Primary Care Providers, OB/GYNs, Office Managers, Specialists, Provider Alert Prior Authorization, genetic testing, Personal Care Services, Prior Authorization Requirements, wheelchair accessory 0 Comments Read more...

19 Nov

Provider Alert! Updates to Prior Authorization Requirements for CADs, electronic bone growth stimulators, home telemonitoring, and hospital beds

Attention: All providers Effective Date: February 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 network providers of Prior Authorization updates. Clinician Administered Drugs (CAD) that require a prior authorization effective February 1, 2021: 90378, [...]

By tcph Primary Care Providers, OB/GYNs, Office Managers, Specialists, Provider Alert Prior Authorization, CADs, Electronic bone growth stimulators, home telemonitoring, hospital beds 0 Comments Read more...

28 Oct

Provider Alert! Prior Authorization Guideline updates for TMJ and Skilled Nursing Facility

Attention: All Providers Effective Date: August 25, 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 you of recent updates to the prior authorization requirements and the effective dates. The following codes for each service [...]

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

Tag - Prior Authorization