Tag - Prior Authorization

Provider Alert!
19Nov

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, Synagis-...

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Provider Alert!
28Oct

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 now...

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Provider Alert!
21Oct

Provider Alert! New prior authorization requirements for Teprotumumab-trbw (Tepezza)

Attention: Ophthalmologists and Endocrinologists Effective Date: January 19, 2021 Call to action: Texas Children’s Health Plan (TCHP) is aligning prior authorization criteria for teprotumumab-trbw (Tepezza), J3241 (formerly procedure code C9061), with the Texas Medicaid Provider Procedures Manual (TMPPM). Tepezza is a clinician administered drug indicated for members with thyroid eye disease (TED). Below are the new prior authorization criteria for TCHP members effective 1/19/2021. For initial therapy, ALL of the following criteria must be met: A diagnosis of Graves’ disease (diagnosis code...

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Provider Alert!
29Sep

Provider Alert! Prior Authorization Update for Botulinum Toxin Benefits with Diagnosis Restriction

  Date: May 20, 2021 Attention: All Providers   Effective Date: May 18, 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 remind providers of the prior authorization requirements for Botulinum Toxin effective October 1, 2020. A prior authorization...

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Provider Alert!
25Sep

Provider Alert! Prior Authorization Update for HCPCS Code H2011, Crisis Intervention

Attention: Behavioral Health Providers Effective Date: September 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) aligns with the prior authorization guidance available in the Texas Medicaid Provider Procedures Manual (TMPPM) for HCPCS Code H2011 Crisis Intervention, per 15...

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Provider Alert!
20Aug

Provider Alert! Prior Authorization Guideline updates for Private Duty Nursing (PDN) and therapy specialty services

Attention: All Providers Effective Date: July 18, 2020 for PDN and August 11, 2020 for therapy Services 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: TCHP would like to inform you of recent updates to the prior authorization requirements and the effective dates. Updates include...

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Provider Alert!
12Aug

Provider Alert! Generic Albuterol Products Return to Non-Preferred Status for Medicaid Members

Attention: All Providers Effective Date: August 28, 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: Beginning August 28, 2020 the Texas Vendor Drug Program (VDP) will restore non-preferred status to a number of generic albuterol products. VDP temporarily removed nonpreferred status from these products...

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Provider Alert!
24Jul

Provider Alert! Medicaid drug formulary changes

Attention: All Providers Effective Date: July 31, 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: The Texas Vendor Drug Program (VDP) will implement changes to the state Medicaid drug formulary, effective Thursday, July 30, 2020. Select medications will be moving from “preferred” to “non-preferred” status and...

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Provider Alert!
24Jul

Provider Alert! Adakveo Update

Attention: Hematologists Effective Date: July 1, 2020 Call to action: Texas Children’s Health Plan (TCHP) aligns with the prior authorization criteria available in the most recent Texas Medicaid Provider Procedures Manual (TMPPM), Clinician Administered Drugs Handbook. Prior authorization guidelines began May 26, 2020. Adakveo, Injection, crizanlizumab - clinician administered drug HCPCS code C9053 is being replaced with Code J0791. This new Code, J0791 will follow the same prior authorization requirements. Adakveo (Crizanlizumab-tmca) is indicated for members with sickle cell disease to reduce the frequency...

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Provider Alert!
07Jul

Provider Alert! Age Limitation Change for Antisense Oligonucleotides Benefits

Attention: Neurologists Effective Date: For dates of service on or after January 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 prior authorization criteria available in the most recent Texas Medicaid Provider Procedures Manual, Clinician Administered...

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