provider alert – Page 13

07AprApril 7, 2020

Provider Alert! COVID-19 Disaster Declaration – ALERT #3 – Prior Authorization Adjustments

Attention: All Providers Effective Date: April 3, 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: As are result of the COVID-19 Disaster Declaration, TCHP has instituted the following changes to our authorization procedures. This alert is an update to our alert on April 2, 2020...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, SpecialistsCOVID, COVID-19, Prior Authorization, provider alert, provider alerts0 CommentsRead more...

06AprApril 6, 2020

Provider Alert! Attention: Early Childhood Intervention (ECI) Providers

Attention: Early Childhood Intervention (ECI) Providers Effective Date: April 3, 2020 Call to action: In accordance with guidance from Texas Medicaid Provider Procedures Manual (TMPPM), providers must use the associated benefit code when submitting claims. How this impacts providers: Changes in billing practices may be required if there are claim denials. Next steps for providers: Billing reminders: Providers should ensure that their claims submissions include their benefit code per TMHP guidelines. If the taxonomy code is attested to a benefit code, the benefit code should be...

By Texas Children's Health PlanProvider Alert, SpecialistsBenefit Code, Early Childhood Intervention, ECI, provider alert, provider alerts0 CommentsRead more...

03AprApril 3, 2020

Provider Alert! Patient Lifts

Attention: Primary Care and DME Providers Effective Date: July 3, 2020 Call to action: In accordance with Texas Medicaid Provider Procedure Manual (TMPPM), patient lifts will require prior authorization, except for E0637 & E0641when billed outside of the benefit limitations. Click here for the Prior Authorization Form. Coding information for lifts as an addition to the mobility aids that are already on the Prior Authorization list. Code Explanation E0630* Hydraulic//mechanical lift. This code has a limit of 1 purchase every 5 years and 1 month rental. E0635* Portable lift....

By Texas Children's Health PlanPrimary Care Providers, Provider Alert, Specialistslifts, Prior Authorization, provider alert, provider alerts0 CommentsRead more...

03AprApril 3, 2020

Provider Alert! COVID-19 Guidance: UPDATE ALERT #5 Telehealth Services: Targeted Case Management through remote delivery

Attention: Behavioral Health, OB/GYN, and ECI Providers Effective Date: April 24, 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 supports Texas Medicaid Healthcare Partnership (TMHP) guidance on Targeted Case Management. This service may be delivered through synchronous audio-visual technologies or telephone (audio-only). Providers should...

By Texas Children's Health PlanOB/GYNs, Provider Alert, SpecialistsCOVID, COVID-19, provider alert, provider alerts, Telehealth, telemedicine, Teleservices0 CommentsRead more...

02AprApril 2, 2020

Provider Alert! Therapeutic Continuous Glucose Monitors Become Benefit of Texas Medicaid

Attention: Primary Care Providers and Endocrinologists Effective Date: April 1, 2020 Call to action: Texas Children’s Health Plan (TCHP) supports Texas Medicaid Health Partnership’s (TMHP) decision to include therapeutic continuous glucose monitors (CGM) as a benefit for Texas Medicaid recipients. A therapeutic CGM device requires prior authorization and is used as a replacement for self-blood glucose monitoring (SBGM). Members who have Type I or Type II diabetes may be considered for therapeutic CGM. All of the following medical necessity criteria must be met. The...

By Texas Children's Health PlanPrimary Care Providers, Provider Alert, Specialistsdiabetes, diabetic, Glucose Monitor, provider alert, Therapeutic0 CommentsRead more...

24MarMarch 24, 2020

Provider Alert! Select an EVV Vendor System or EVV Proprietary System Update

Attention: Financial Management Services Agencies (FMSA) Effective Date: May 1, 2020 Due to impacts of coronavirus, HHSC is extending the deadline to May to select an EVV system and begin the onboarding process. The original deadline was April 1,2020. Therefore, Financial Management Services Agencies (FMSAs) must select an Electronic Visit Verification or EVV Vendor System or EVV Proprietary System by May 1, 2020. How this impacts providers: All FMSAs currently contracted with MCOs or the Texas Health and Human Services Commission (HHSC). Next steps for...

By Texas Children's Health PlanOffice Managers, Provider AlertCOVID, COVID-19, EVV, FMSA, hhsc, provider alert, provider alerts0 CommentsRead more...

23MarMarch 23, 2020

Provider Alert! Reminder of mailing address and procedure for overpayments

Attention: All Providers Effective Date: March 20, 2020 Should a provider receive an overpayment from Texas Children’s Health Plan they should immediately take the following action. A provider has an obligation to notify Texas Children’s Health Plan in writing upon identification of an overpayment, no more than thirty (30) days from the date of discovery. The overpayment can be remediated through refund to Texas Children’s Health Plan, or a provider may request a recoupment from future claim payments. For refunds: If a provider wishes...

By Texas Children's Health PlanOB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialistsbilling, overpayment, provider alert, provider alerts0 CommentsRead more...

23MarMarch 23, 2020

Provider Alert! New “Black Box” warning for Singulair (montelukast) and generic formulations

Attention: PCPs, Pulmonologists, and Pharmacists Effective Date: March 20, 2020 After careful analysis of the benefits and risks, the Food and Drug Administration (FDA) has strengthened the existing warnings on potential side effects on all Singulair and generic montelukast formulations. A “Black Box” warning has been included to stress the potential for serious side effects, including but not limited to serious behavior and mood-related changes. The FDA has also advised restricting the use for allergic rhinitis (hay fever) to those not treated...

By Texas Children's Health PlanPrimary Care Providers, Provider Alert, Specialistsprovider alert, provider alerts, Singulair0 CommentsRead more...

19MarMarch 19, 2020

Provider Alert! COVID-19 Disaster Declaration – Texas Children’s Health Plan Operational Adjustments

Attention: All Providers Effective Date: March 13, 2020 TCHP affiliated providers should monitor the 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: Reporting adjustments to normal provider business operations Texas Children’s Health Plan has developed a provider notification survey which is posted on the Provider portal www.texaschildrenshealthplan.org/for-providers and the website. This survey allows providers to...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, SpecialistsCOVID, COVID-19, operations, provider alert, provider alerts0 CommentsRead more...

19MarMarch 19, 2020

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

Attention: All Providers Effective Date: March 18, 2020 TCHP affiliated providers should monitor the 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: As are result of the COVID-19 Disaster Declaration, TCHP has instituted the following: In order to increase access to primary care services, TCHP is now waiving prior authorization requirements for out-of-network primary care...

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