Prior Authorization – Page 5

28JulJuly 28, 2022

Provider Alert! Prior Authorization Criteria Update for Breyanzi and Kymriah

Date: July 27, 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 Breyanzi...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialistsbreyanzi, Kymriah, lymphoma, Prior Authorization0 CommentsRead more...

13JulJuly 13, 2022

Provider Alert! Removal of Specialist Requirements from CAD Clinical Policies and Prior Authorization Criteria

Date: July 13, 2022 Attention: Providers Effective Date: August 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: HHSC is updating the prior authorization criteria for some clinician administered drugs. How this impacts providers: HHSC will no longer require the prescription include consultation with or be...

By tcphUncategorizedCADs, Prior Authorization0 CommentsRead more...

13JulJuly 13, 2022

Provider Alert! All MCOs: Dupixent, Evrysdi, and Qelbree Clinical Prior Authorization Criteria Updates

Date: July 13, 2022 Attention: Providers Effective Date: August 2, 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: HHSC is revising the prior authorization (PA) criteria for the following drugs: Dupixent, Evrysdi and Qelbree. How this impacts providers: HHSC made the following revisions: Dupixent clinical PA criteria: Added...

By tcphOB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialistsdupixent, Evrysdi, Prior Authorization, Qelbree0 CommentsRead more...

13JulJuly 13, 2022

Provider Alert! Removal of Specialist Requirements from CAD Clinical Policies and Prior Authorization Criteria

By tcphOB/GYNs, Office Managers, Primary Care Providers, Provider Alert, SpecialistsCADs, Prior Authorization0 CommentsRead more...

30JunJune 30, 2022

Provider Alert! Prior Authorization Criteria Update for Rinvoq and Cibinqo

Date: June 28, 2022 Attention: All Providers Effective Date: August 31, 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. TCHP will apply updates and reprocess impacted claims as soon as possible. However, please allow up to sixty (60) business days for reprocessing. Providers are not required to appeal...

By Texas Children's Health PlanUncategorizedankylosing spondylitis, atopic dermatitis, Cibinqo, Prior Authorization, Rinvoq0 CommentsRead more...

15JunJune 15, 2022

Provider Alert! Prior authorization criteria for Voxzogo (Vosoritide)

Date: June 15, 2022 Attention: All Providers Subject: Prior authorization criteria for Voxzogo (Vosoritide) Effective Date: July 15, 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 July 15, 2022, Texas Children’s Health Plan (TCHP) will implement the Voxzogo clinical edit in-line with the Health and...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialistsachrondroplasia, epiphyses, Prior Authorization, Vosoritide, Voxzogo0 CommentsRead more...

15JunJune 15, 2022

Provider Alert! Prior Authorization Criteria Update for Aduhelm Begins July 1

Date: June 15, 2022 Attention: All Providers Subject: Prior Authorization Criteria Update for Aduhelm Begins July 1 Effective Date: July 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 that the Health and Human Services Commission...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialistsabnormalities, Aduhelm, amyloid, ARIA, imaging, Prior Authorization0 CommentsRead more...

02JunJune 2, 2022

Provider Alert! Prior Authorization Criteria Updates for Yescarta and Tecartus

Date: June 1, 2022 Attention: All Providers Effective Date: July 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 prior authorization criteria for Yescarta (Q2041)...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, SpecialistsALL, cancer, leukemia, lymphoma, Prior Authorization, tecartus, yescarta0 CommentsRead more...

25MayMay 25, 2022

Provider Alert! Push-rim Activated Power Assist Wheelchair (PAPAW) System Procedure Code E0986 to Become a Benefit for Texas Medicaid

Date: May 25, 2022 Attention: All Providers Effective Date: June 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 effective for dates of service on or after June 1, 2022, push-rim activated power assist...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialistsbenefit, medicaid, PAPAW, Prior Authorization, wheelchair0 CommentsRead more...

11AprApril 11, 2022

Provider Alert! Laser Interstitial Thermal Therapy to Require Prior Authorization

Date: April 6, 2022 Attention: Radiologists Effective date: July 5, 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. Regarding system configuration updates, TCHP will apply updates and reprocess impacted claims as soon as possible. However, due to volume, please allow up to sixty (60) business days...

By Texas Children's Health PlanProvider Alert, SpecialistsLaser, Laser Interstitial Thermal Therapy, Prior Authorization, Radiologists0 CommentsRead more...

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