Prior Authorization – Page 3

09MayMay 9, 2023

Provider Alert! Subject: Unclassified Medical Drugs Prior Authorization Requirement

Date: May 8, 2023 Attention: All Providers Effective Date: June 8, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective June 8 2023, medical claims under $5,000 submitted to TCHP with unclassified Healthcare Common Procedure Coding System (HCPCS) code J3490 will no longer require a pre-service (prior authorization) request as claims above this cost will be subject to clinical necessity review by the pharmacy team. This dollar limit does not apply to other unclassified codes J9999, J3590,...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, SpecialistsHCPCS, Prior Authorization, Unclassified Medical Drugs, VDP, Vendor Drug Program0 CommentsRead more...

25AprApril 25, 2023

Provider Alert! Lidocaine 5% Patch Added To PDL

Date: April 21, 2023 Attention: All Providers Effective Date: April 3, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective April 3, 2023, the Texas Health and Human Services Commission (HHSC) temporarily removed the non-preferred status from the generic product, Lidocaine 5% patches on the preferred drug list (PDL). The preferred status of the brand name products (NDC 63481-0687-06) will not change to allow for any existing stock available to be utilized. This is in response...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialistslidocaine, PDL, Preferred Drug List, Prior Authorization0 CommentsRead more...

05JanJanuary 5, 2023

Provider Alert! Prior Authorization Criteria Update for Amvuttra

Date: December 29, 2022 Attention: All Providers Effective date: February 1, 2023 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, February 1,2023, the Texas Health and Human Services Commission (HHSC) will update the prior authorization criteria for Amvuttra (procedure code J0225). Amvuttra (vutrisiran) is a transthyretin-directed...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, SpecialistsAmvuttra, Amyloidosis, HATTR, Prior Authorization0 CommentsRead more...

28DecDecember 28, 2022

Provider Alert! Synagis Prior Authorization Guidance – Reminder

Date: December 28, 2022 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: Beginning with the 2022-23 Human Respiratory Syncytial Virus (RSV) season, the Texas Health and Human Services Commission (HHSC) implemented simplified approval criteria for Synagis subsequent dosing (renewals). Pharmacies will no...

By Texas Children's Health PlanOB/GYNs, Office Managers, Primary Care Providers, Provider Alert, SpecialistsPrior Authorization, RSV, Synagis0 CommentsRead more...

06DecDecember 6, 2022

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

Date: November 30, 2022 Attention: All ProvidersEffective Date: November 21, 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 January 31, 2023. 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 PlanOB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialistsadjustment, COVID, COVID-19, disaster declaration, Prior Authorization0 CommentsRead more...

29NovNovember 29, 2022

Provider Alert! Prior Authorization Criteria for Carvykti Begins December 1, 2022

Date: November 28, 2022 Attention: Providers Subject: Effective date: December 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) will revise clinical prior authorization criteria for Carvykti (Ciltacabtagene autoleucel) effective December 1, 2022. It is a B-cell maturation antigen-directed genetically...

By Texas Children's Health PlanOB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialistscancer, Carvykti, multiple myeloma, Prior Authorization, REMS0 CommentsRead more...

22NovNovember 22, 2022

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 changes...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, SpecialistsCOVID, COVID-19, Prior Authorization, waiver0 CommentsRead more...

15NovNovember 15, 2022

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 of...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, SpecialistsCGRP Antagonists, Prior Authorization, Prophylaxis, Revision0 CommentsRead more...

07NovNovember 7, 2022

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 as...

By Texas Children's Health PlanOB/GYNs, Office Managers, Primary Care Providers, Provider Alert, SpecialistsCase Management, mental health rehabilitation, Prior Authorization, prior authorization updates, targeted case management0 CommentsRead more...

26OctOctober 26, 2022

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 impacts...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialistsclinical criteria, cystic fibrosis, FDA, orkambi, Prior Authorization0 CommentsRead more...

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