Tag - provider alert

Provider Alert!
18Jun

Provider Alert! Home Health DME and Supplies Exceptional Circumstances Provision for Medicaid Members 21 years of age and older

Attention: DME Providers Effectvie Date: June 1, 2020 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 aligns with the Texas Medicaid and Healthcare Partnership (TMHP) new guidance for Durable Medical equipment (DME) and supplies under exceptional circumstances. Effective June 1, 2020...

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Provider Alert!
17Jun

Provider Alert! Additional Diagnosis Codes and Place of Service Added for Ravulizumab-cwvz (Ultomiris)

Attention: Hematologists, Gastroenterologists, Rheumatologists Effective Date: June, 1 2020 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 you that we align with Texas Medicaid Provider Procedure Manual (TMPPM) regarding the guidelines for ravulizumab-cwvz, (Ultomiris), procedure code J1303....

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Provider Alert!
12Jun

Provider Alert! Positive Pressure Airway (PAP) device guideline

Attention: All Providers Effective Date: June 17, 2020 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: TCHP would like to inform you of recent updates to the guidelines for home health, speech therapy, and positive pressure airway (PAP) devices. Updates include the following: Home health guideline:...

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Provider Alert!
12Jun

Provider Alert! Updates to Behavioral Health Inpatient and Outpatient Testing Evaluations

Attention: Behavioral Health Providers and Inpatient Facilities Effective Date: January 1, 2019 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 January 1, 2019, the benefit criteria for psychological, neurobehavioral, and neuropsychological testing for inpatient behavioral health and outpatient mental health services has changed for...

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Provider Alert!
12Jun

Provider Alert! Updated reimbursement information for Inpatient Genetic Services

Attention: Geneticist Effective Date: May 1, 2020 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: TCHP would like to inform you of a recent update to the reimbursement information for inpatient genetic service codes 99254 and 99255. Effective for dates of service on or after...

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Provider Alert!
01Jun

Provider Alert! Prior authorizations for hospital beds reminder and new codes added

Attention: All Providers Effective date for new codes: August 26, 2020 Call to action: Texas Children’s Health Plan (TCHP) would like to remind you that the following hospital beds and accessories’ codes require prior authorization. This follows the guidance from the Texas Medicaid Provider Procedures Manual (TMPPM).   Code Description E 0184 Dry pressure mattress E0185 Gel or gel-like pressure pad for mattress, standard mattress length E0186 Air pressure mattress E0187 Water pressure mattress E0188 Synthetic sheepskin pad E0189 Lamb’s wool sheepskin pad, any size E0190 Positioning cushion/pillow/wedge, any shape or size E0193 Powered air flotation bed (low air loss therapy) E0194 Air...

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Provider Alert!
28May

Provider Alert! Adakveo Update

Attention: Hematologists Effective Date: May 26, 2020 Call to action: Adakveo, Injection, crizanlizumab - clinician administered drug HCPCS code C9053 is an at risk drug. Currently, there is no prior authorization required; however, beginning May 26, 2020 authorization guidelines will be in place. The required criteria to receive Adakveo include: HbSS (sickle cell) diagnosis Patients over the age of 16 years-old Patients that have experienced more than two vaso-occlusive crisis (VOC) events in the past 12-months How this impacts providers: Prescribers should adhere to the guidelines and acquire...

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Provider Alert!
28May

Provider Alert! Housing Choice Plan Survey

Attention: All Providers Effective Date: Survey open May 15, 2020 until June 15, 2020 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: The Health and Human Services Commission’s (HHSC) Behavioral Health Advisory Committee has approved the development of a Housing Choice Plan for individuals with...

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Provider Alert!
27May

Provider Alert! Secretion and Mucous Clearance Device Update on rental option

Date: December 17, 2021 Attention: Pulmonologists and DME providers Effective Date: June 1, 2020 for Intrapulmonary Percussive Ventilation (IPV) rental information Call to action: update for December 17, 2021: Intrapulmonary Percussive Ventilation (IPV)*: effective June 1, 2020, this device is available for rent only and no longer has the rent to purchase option. Secretion and mucous clearance devices will require prior authorization except for percussion cups. Here is the link to the Prior Authorization Form: https://www.tmhp.com/sites/default/files/provider-forms/pa-forms/F00145_Prior_Auth_for_Secretion_and_Mucus_Clearance_Devices_Initial.pdf Information on coding for devices: Device Code Intrapulmonary Percussive Ventilation (IPV)* E0481. TCHP...

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21May

Register for the June CME: COVID-19 Looking to the Future

COVID-19 – Looking to the Future: Where are we now and where do we go from here? Presented by Texas Children’s Health Plan Wednesday, June 17, 2020 – 5:30-7:30 p.m. – Live stream via WebEx Topics covered will include: Progress toward a COVID-19 Vaccine Fall 2020: Managing COVID-19 and the Flu in a Pediatrics Practice Telemedicine: How to Keep the Momentum Going Q&A with Dr. Lisa Hollier The CME will be presented by: Dr. Mark Ward Director, Pediatric Residency Program Baylor College of Medicine/Texas Children’s Hospital Dr. Robert Ball Medical Director, eHealth Texas Children’s...

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