Tag - provider alert

Provider Alert!

Provider Alert! Smoking Cessation Benefits

Call to action: This notice is regarding the risk of severe lung disease among individuals who vape. Providers are reminded that screening and information on smoking cessation should be included as part of any routine patient visit.  In addition to the services and support available through CHIP and Medicaid Texas Children’s Health Plan offers value added smoking cessation benefits to its active members. How this impacts providers: Providers should educate susceptible patients presenting with respiratory symptoms or other related health [...]

Provider Alert!

Provider Alert! Respite Care Services

Call to action: Texas Children’s Health Plan (TCHP) offers a respite care value-added service for STAR Kids members.  Respite care provides temporary relief for parents or legally authorized representatives who are caring for a child with special needs.  TCHP offers 24 hours of in-home respite care service per calendar year as an extension of home and community-based services. How this impacts providers: This value-added service applies to TCHP STAR Kids members that are not already receiving respite care services through [...]

Provider Alert!

Provider Alert! : Initial Specialty Therapy Evaluations no longer require an Authorization

Effective Date: September 1, 2019 Call to action: Initial specialty therapy (occupational, physical, speech therapy) evaluations do not require prior authorization effective September 1, 2019. How this impacts providers: In an effort to ensure our in-network providers can provide specialty therapy evaluations within 21 days of submission of a signed referral, Texas Children’s Health Plan (TCHP) will no longer require prior authorization for in-network specialty therapy evaluations billed within the guidance of the current Texas Medicaid Provider Procedure Manual (TMPPM). Next steps for [...]

Provider Alert!

Provider Alert! TMHP EVV Prospective Process

Attention: All TCHP STAR Kids LTSS Providers Requiring EVV Subject: TMHP EVV Prospective Process Effective Date:  Effective 9/01/2019, the Texas Health and Human Services Commission (HHSC) will implement their new EVV claims matching process. Claims with a date of service on 9/01/2019 or later will be required to be sent to the Texas Medicaid & Healthcare Partnership (TMHP) for claims matching. After this date, all claims submitted directly to Texas Children’s Health Plan with a date of service on 9/01/2019 or [...]

Provider Alert!

Provider Alert! Mandatory HHSC Webinar Training

7/23/2019 Attention: Financial Management Services Agencies (FMSA) HHSC is providing a webinar training for financial management services agencies (FMSAs). All FMSAs currently contracted with MCOs or HHSC must attend this mandatory training. When: Monday, July 29th at 1:30 p.m. Where: Online webinar, Register here: https://register.gotowebinar.com/register/6419407779512242946 What to expect: Consumer Directed Services (CDS) updates and reminders EVV updates   NOTE: Go to https://support.logmeininc.com/gotomeeting/get-ready  to run a test of your computer’s connectivity if you have never attended a Webinar from your computer. You can run this test at any time prior to the [...]

Provider Alert!

Provider Alert! TCHP Prior Authorization Requirements

Date:  July 1, 2019 Subject: TCHP Prior Authorization Requirements Effective October 1, 2019, TCHP has updated the prior authorization listing. Please note there are some key changes for providers.   Added:            Case by Case Added Services This category includes CPT/HCPCS codes that are listed as not payable in the TMHP fee schedule. Clinician Administered Drugs that Require Authorization Please refer to the Prior Authorization Reference Information document for specific codes that fall under this category. This document can be found at: https://www.texaschildrenshealthplan.org/for-providers/provider-resources   DME Repair [...]

Provider Alert!

Provider Alert! Reminder: Texas Children’s Health Plan Claims Editing System (CES) Update

Attention:  All Providers Update: Texas Children’s Health Plan Claim Editing System Texas Children’s Health Plan (TCHP) recently sent a Provider Alert updating our plan to transition to a new Claims Editing System (CES) by Optum on May 31, 2019. Please be advised this transition will now include edits specific to Texas and National Medicaid and the transition will occur in June 2019. This was initially scheduled to be done later in the year as another phase of the project, however [...]

Provider Alert!

Provider Alert! Health Insurance Portability and Accountability Act (HIPAA) Compliant Reasons for Denials and Adjustments

Attention:  All Providers Health Insurance Portability and Accountability Act (HIPAA) Compliant Reasons for Denials and Adjustments   Beginning May 15, 2019, Texas Children’s Health Plan (TCHP) providers will see positive changes to their HIPAA standard 835 electronic remittance and paper explanations of payments (EOPs). TCHP will be providing more robust and HIPAA compliant messages by utilizing national standard claim adjustment reason codes (CARCs) and remittance advice remark codes (RARCs). What are CARCs and RARCs? CARCs and RARCs are industry standard code sets used to [...]

Provider Alert!

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

Attention:  All Providers Reminder: Texas Children’s Health Plan Claim Editing System Update   Texas Children’s Health Plan (TCHP) previously sent a Provider Alert notifying providers that an intended transition to a new Claims Editing System (CES) by Optum was to occur in December 2018. Please be advised that this transition will now be occurring May 31, 2019.  Any claims submitted May 31, 2019 and after, including corrected and adjusted claims, will be processed with the Optum CES edits. TCHP is required by Texas [...]

Provider Alert!

Provider Alert! Governor Greg Abbott Issues Disaster Declaration for Cherokee, Freestone, Houston, Leon, Madison, Nacogdoches, Robertson, San Augustine, and Shelby Counties.

On April 18, 2019: Governor Greg Abbott issued a disaster declaration for the following counties Cherokee, Freestone, Houston, Leon, Madison, Nacogdoches, Robertson, San Augustine, and Shelby counties. If a member resides in one of these impacted areas named above Texas Children’s Health Plan will make every effort to assist them in obtaining medically necessary services. PHARMACY: Navitus Pharmacy update related to disaster declaration: Navitus has implemented the "Disaster Declaration and Refill Too Soon" process as a result of the severe weather, including thunderstorms and tornado [...]