Tag - provider alert

Provider Alert! Follow-up on Billing Provider Taxonomy Claims Requirement Effective September 1, 2018

Clearing House Process Verification: Please verify with your clearing house that the TMHP attested billing provider taxonomy is being transmitted on claims for all products. Through collaborative work with provider groups, it has been identified that some clearing houses have been removing the billing taxonomy code on claims prior to submitting to the health plan for processing resulting in claims denials. Billing provider taxonomy is a requirement effective 9/1/2018. Because providers use a variety of clearing houses for claims submission, your [...]

Provider Alert! TCHP Prior Authorization Requirement

Effective January 1, 2019, TCHP will be updating the prior authorization listing. Please note there are some key changes for providers. Removed from the list and will no longer require prior authorization: Baclofen Pump New to the list: Home Telemonitoring Updates: Ambulance (non-emergent transport) has been updated to Non-Emergency Ambulance Transport. Augmentative Communication Device has been updated to Augmentative Communication Device and Accessories. Chemotherapy non-FDA approved has been updated to Non-FDA approved medications. Cranial Molding Orthosis (Helmets) has been updated to Cranial Molding Orthosis. High cost (>$50,000) injectable in the [...]

Provider Alert! Texas Standard Prior Authorization Request Form compliance grace period has ended

Starting January 1, 2019, the 90-day grace period for compliance with the exclusive use of the Texas Standard Prior Authorization Request Form has ended. From this date forward, providers must use the Texas Standard Prior Authorization Request Form, which can be found at: https://www.texaschildrenshealthplan.org/for-providers. Click on Downloadable Forms on the left-hand side, then click Standard Prior Authorization Form or Behavioral Health Authorization Form to download. As a reminder, the following essential information is required to start the authorization process: Member Name, Member [...]

Provider Alert! Reminder – LTSS Enrollment Deadline Extended to October 31, 2018

Attention:  Long Term Services and Supports Providers (LTSS) Subject:  Reminder - Enrollment Deadline Extended to October 31, 2018   This is a reminder that the enrollment deadline for Long Term Support Services (LTSS) providers serving MCO members is quickly approaching. Long Term Support Services (LTSS) providers serving MCO members are required to enroll through the Medicaid MCO LTSS provider enrollment process.   To allow sufficient time for application processing, MCO LTSS providers are strongly advised to submit applications as soon as possible.   An MCO LTSS [...]

Provider Alert! Texas Children’s Health Plan Claim Editing System Update

Attention:  All Providers Subject: Texas Children’s Health Plan Claim Editing System Update Effective: 12/27/2018   Texas Children’s Health Plan intends to transition to a new Claims Editing System (CES) by Optum on 12/27/2018. Please be aware that claims submitted prior to 12/27/2018 will continue to be processed by our current vendor, McKesson Claim Check. TCHP is required by Texas Health and Human Services to ensure all required claims edits are consistently applied. Migrating to Optum CES will enable TCHP to efficiently apply all required [...]

Provider Alert! Neonatal Level of Care Designation Updates

Date: August 28, 2018 Attention:  All Hospitals  Subject:  Neonatal Level of Care Designation Updates Effective for dates of service on or after September 1, 2018, hospitals enrolled in Texas Medicaid may be reimbursed for inpatient neonatal services only if the hospitals have received a neonatal level of care designation from the Department of State Health Services (DSHS) in accordance with 25 Texas Administrative Code §§133.181-133.190. Requirements: Hospitals with neonatal units must have a level of care designation.  Information on these requirements and an application [...]

Provider Alert! New Claims Requirements Effective September 1, 2018

Date: August 20, 2018 New Claims Requirements Effective September 1, 2018 Attention:  Network Providers   Billing taxonomy Per section 6.2.1 of the TMPPM Billing providers must submit the taxonomy number on all electronic claims with the exception of Medicare primary claims. Electronic claims without a billing taxonomy will be rejected.   Claim Requirement Electronic Claim Billing Provider Taxonomy Code (required on all claims) 2000A, PRV03   Ordering/Referring Provider Requirement For services that require an ordering/referring provider the NPI of the ordering/referring provider must be attested. Billing providers can verify an ordering/ [...]

Provider Alert! Changes to physical, occupational and speech therapy benefits for all ages

Effective for dates of service on or after September 1, 2017, physical therapy (PT), occupational therapy (OT) and speech therapy (ST) benefits for all ages will change for Texas Medicaid. Please visit the TMHP website to review for changes to this medical benefit policy that applies to the following: Billing structure changes for PT, OT and ST services Procedure codes end-dating August 31, 2017 Required modifiers Claims filing changes Clarification to benefits Providers may refer to the current Texas Medicaid Provider Procedures Manual, Physical Therapy, Occupational [...]

Provider Alert! Prior Authorization of Texas Health Steps (THSteps) dental therapy under general anesthesia for members who are six years of age or younger

Effective July 1, 2017, Texas Children’s Health Plan will be required to implement prior authorization for Level 4 deep sedation and general anesthesia provided in conjunction with therapeutic dental treatment for Medicaid dental clients from ages 0 through six years. All Level 4 services must be authorized prior to rendering services. Anesthesia services provided by a dentist should use procedure code D9223. Any anesthesia services provided by an anesthesiologist (M.D./D.O.) or certified registered nurse anesthetist (CRNA), should use procedure code [...]

Provider Alert! Benefit Changes Prior Authorization Update

Attention: All Texas Children’s Health Plan Providers Subject: UPDATE to Changes for Physical, Occupational, and Speech Therapy Benefits   Prior Authorization Changes Update Changes to TCHP Prior Authorizations for PT, OT, and ST services: For therapy authorizations with approved dates of service spanning the 9/1 transition date, TCHP created a revised authorization in our system that reflects the new billing structure using the same authorization number. For all therapy requests that were submitted prior to 9/1, the revised authorization will start on 9/1 and cover through the end [...]