Tag - provider alert

Provider Alert!
12Oct

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 coding...

By Provider Alert, , , , 0 CommentsRead more...
Provider Alert!
12Oct

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 can...

By Provider Alert, , , 0 CommentsRead more...
Provider Alert!
01Sep

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/ referring...

By Provider Alert, , , , 0 CommentsRead more...
Provider Alert!
27Sep

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 Therapy...

By Provider Alert, , , , , , , 0 CommentsRead more...
Provider Alert!
17Sep

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 00170,...

By Office Managers, Provider Alert, , , 0 CommentsRead more...
Provider Alert!
11Sep

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 of...

By Provider Alert, Specialists, , 0 CommentsRead more...
Provider Alert!
22Aug

Provider Alert! Financial Management Service Agency (FMSA)

Subject: Financial Management Service Agency(FMSA) Registration is now open for the Annual Financial Management Service Agency (FMSA) training scheduled for September 19, 2017, 8:30am-5:00pm. This training is mandatory for FMSAs per contracting requirements in Texas Administrative Code, Rules 41.301 and 49.302. In order to comply with this requirement. This required training is now offered in two formats: the FMSA may choose to either attend in-person or by webinar. The in-person training will be at the Winters building located at 701 W. 51st St., Austin, Texas 78751,...

By Provider Alert, Uncategorized, 0 CommentsRead more...
Provider Alert!
07Jul

Provider Alert! Changes to Physical, Occupational, and Speech Therapy Benefits for All Ages

Subject: 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 review http://www.tmhp.com/News_Items/2017/06-June/06-30- 17%20Physical,%20Occupational,%20and%20Speech%20Therapy%20Benefits%20for%20All%20Ages%20 to%20Change%20for%20Texas%20Medicai.pdf 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...

By Provider Alert, , 0 CommentsRead more...
Provider Alert!
05Jul

Provider Alert! FAQS: Ordering, Referring, and Prescribing Providers

Ordering, Referring, and Prescribing Providers Frequently Asked Questions 1) What is the new enrollment requirement for ordering, referring, and prescribing providers? –– Federal regulations at 42 CFR 455.440 require claims for payment of items or services that were ordered, referred or prescribed to contain the National Provider Identifier of the physician or other professional who ordered, referred or prescribed the items or services. Additionally, federal regulation 42 CFR 455.410 requires all ordering, referring or prescribing providers to be enrolled as participating providers in...

By Provider Alert, , , 0 CommentsRead more...