Prior Authorization – Page 4

26OctOctober 26, 2022

Provider Alerts! Cosentyx Clinical Prior Authorization Criteria Revision Scheduled for November 22

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 Cosentyx to comply with the recent Food and Drug Administration-approved age indications. How this impacts providers:...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialistsarthritis, cosentyx, Navitus, Prior Authorization, psoriasis, psoriatic arthritis0 CommentsRead more...

18OctOctober 18, 2022

Provider Alert! RSV Fall/Winter Traditional Season Regional Changes Begin October 17

Date: October 17, 2022 Attention: All Providers Effective Date: October 17, 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: Traditional Respiratory Syncytial Virus (RSV) season is here. Texas Children’s Health Plan (TCHP) would like to let providers know that effective October 17, 2022, the Texas...

By Texas Children's Health PlanOB/GYNs, Office Managers, Primary Care Providers, Provider Alert, SpecialistsBenefits, Pharmacy, Prior Authorization, refill, Respiratory Syncytial Virus, RSV0 CommentsRead more...

12OctOctober 12, 2022

Provider Alert! PDL Prior Authorization Criteria Revisions Scheduled for October 11

Date: October 11, 2022 Attention: All Providers Effective Date: October 11, 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: Effective October 11, 2022, Texas Children's Health Plan (TCHP) will revise the preferred drug list (PDL) prior authorization criteria guide for the Bronchodilators, Beta Agonists,...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, SpecialistsBeta Agonists, Bronchodialators, Glucagon Agents, PDL, Prior Authorization0 CommentsRead more...

06OctOctober 6, 2022

Provider Alert! Clinical Prior Authorization Criteria Revisions Implement for Medicaid Fee-for-Service on October 26

Date: October 5, 2022 Attention: All Providers Subject: Effective Date: October 26, 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 the clinical prior authorization criteria for the Anxiolytics and Sedative/Hypnotics (ASH), Attention Deficit Disorder/Attention-Deficit Hyperactivity Disorder (ADD/ADHD), and Qelbree (also within the...

By Texas Children's Health PlanEvents, Facilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialistsadd, ADHD, Anxiolytics, Hypnotic, Medicaid Fee For Service, Prior Authorization, Sedative0 CommentsRead more...

03OctOctober 3, 2022

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

Date: October 3, 2022 Attention: All Providers Effective Date: September 26, 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 October 31, 2022. This COVID-19 Disaster Declaration extension does NOT apply to 90-day authorizations. As of January 1, 2021, 90-day authorization...

By Texas Children's Health PlanOB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialistsadjustment, COVID, COVID-19, disaster declaration, Prior Authorization, Utilization Management0 CommentsRead more...

26SepSeptember 26, 2022

Provider Alert! Drug Regimen Optimization Edit Removed After September 12

Date: September 20, 2022 Attention: All Providers Effective Date: September 12, 2022 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated with 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 September 12, 2022, Texas Children's Health Plan (TCHP) will remove the Drug Regimen Optimization prior authorization for all drugs except ADHD drugs. The Health...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialistsadd, ADHD, drug, Drug Regimen, Optimization, Prior Authorization0 CommentsRead more...

26SepSeptember 26, 2022

Provider Alert! Prior Authorization Criteria Update for Adakveo

Date: September 20, 2022 Attention: All Providers Effective Date: December 1, 2022 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated with 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, 2022, the Health and Human Services Commission (HHSC) will update prior authorization criteria for Adakveo (procedure code J0791). HHSC updated the prior...

By Texas Children's Health PlanOB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialistsadakveo, Prior Authorization, sickle cell0 CommentsRead more...

26SepSeptember 26, 2022

Provider Alert! Prior Authorization Criteria Update for Zolgensma

Date: September 20, 2022 Attention: All Providers Effective Date: November 11, 2022 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated with 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 that effective November 1, 2022, the Health and Human Services Commission (HHSC) will update the...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, SpecialistsPrior Authorization, Zolgensma0 CommentsRead more...

13SepSeptember 13, 2022

Provider Alert! Prior Authorization Criteria to Change for Some CAR T-Cell Infusion Therapies

Date: September 13, 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 with 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 that the Health and Human Services Commission (HHSC) will update the prior authorization criteria for...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialistsbreyanzi, cancer, Infusion, Infusion Therapy, lymphoma, Prior Authorization, T-Cell, yescarta0 CommentsRead more...

25AugAugust 25, 2022

Provider Alert! Clinical Prior Authorization for Xenical No Longer Required After September 12, 2022

Date: August 19, 2022 Attention: All Providers Subject: Clinical Prior Authorization for Xenical No Longer Required After September 12, 2022 Effective Date: September 12, 2022 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated with 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 that beginning September...

By Texas Children's Health PlanOB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialistsobesity, Prior Authorization, weight loss0 CommentsRead more...

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