Tag - Prior Authorization

Provider Alert!
28Jan

Provider Alert! Prior Authorization Criteria for Tecartus Updated January 1, 2021

Date: January 26, 2021 Attention: Oncologists 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) follows the clinical prior authorization criteria for Tecartus (Procedure Code C9073), presented by the Health and Human Services Commission (HHSC). Tecartus (C9073)...

By Provider Alert, Specialists, , 0 CommentsRead more...
Provider Alert!
28Jan

Provider Alert! Prior Authorization Criteria for Uplizna

Date: January 19, 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 would like to inform network providers that the Health and Human Services Commission (HHSC) has added Texas Medicaid and CHIP prior authorization...

By OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialists, , 0 CommentsRead more...
Provider Alert!
28Jan

Provider Alert! Evrsydi available on Medicaid formulary with prior authorization requirements on Feb 1

Date: January 25, 2021 Attention: Neurologists and SMA specialists 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: Prescribers should be aware that Evrysdi will be available to members through Texas Medicaid pharmacy benefit effective February 1. Access will require meeting clinical prior authorization criteria for Evrysdi (risdiplam).  Evrysdi is indicated for treatment...

By Provider Alert, Specialists, , 0 CommentsRead more...
Provider Alert!
15Jan

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 Name Member...

By OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialists, 0 CommentsRead more...
Provider Alert!
08Jan

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 Legislature,...

By Provider Alert, Specialists, , , 0 CommentsRead more...
Provider Alert!
07Jan

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 prior...

By Provider Alert, Specialists, , , 0 CommentsRead more...
Provider Alert!
22Dec

Provider Alert! Prior Authorization Requirements Guide

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 effective March 8, 2021.Below are the services by category to...

By OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialists0 CommentsRead more...
Provider Alert!
07Dec

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

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 occupational therapy provided in the...

By Primary Care Providers, Provider Alert, Specialists, 0 CommentsRead more...
Provider Alert!
30Nov

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, HHSC...

By Provider Alert, Specialists, 0 CommentsRead more...
Provider Alert!
19Nov

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) (eg,...

By OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialists, , , , 0 CommentsRead more...