Tag - provider alert

Provider Alert!
27Jun

Provider Alert! Authorization Extension for STAR Kids Members (Revised)

The Health and Human Services Commission (HHSC) expects managed care organizations to extend longterm services and supports (such as Personal Care Services, Community First Choice, and Private Duty Nursing) authorizations for services until completion of the STAR Kids Screening and Assessment Instrument (SAI), but no longer than July 1, 2017. In compliance with HHSC’s guidance and as required by the STAR Kids contract, STAR Kids managed care organizations must assess each enrolled member by completing the STAR Kids Screening and Assessment...

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12Jun

Provider Alert! Codeine and Tramadol should NOT be prescribed for children

On April 20, 2017 the US Food and Drug Administration (FDA) issued a statement that CODEINE is CONTRAINDICATED for treatment of pain or cough for children under 12 years. The also WARN against its use in adolescents 12-18 years old, especially those with obesity, obstructive sleep apnea, or severe lung disease.   The FDA considers TRAMADOL to be CONTRAINDICATED for children younger than 18 to treat pain from tonsillectomy or adenoidectomy.   Note that Tramadol is not FDA approved for use in...

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Provider Alert!
25May

Provider Alert! New Fax Number for STAR Kids Private Duty Nursing Prior Authorization

Attention STAR Kids Providers Texas Children’s Health Plan New Fax Number for STAR Kids Private Duty Nursing Prior Authorization To expedite the prior authorization process for Texas Children’s Health Plan for STAR Kids, please begin faxing to 346-232-4757 for outpatient prior authorization for the following service. Private Duty Nursing The Prior Authorization Request Form is conveniently located on the STAR Kids website at http://www.texaschildrenshealthplan.org/sites/default/files/pdf/20150410_Standard%20Prior%20Auth%20Form.pdf. Please contact your dedicated Provider Service Representative toll-free at 1-800-731-8527 with any questions. Thank you for your commitment to your Texas Children’s Health...

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Provider Alert!
19May

Provider Alert! Enrollment Information for CHIP Providers

Attention CHIP Providers Enrollment Information Specific to CHIP Providers Federal law and regulation require states to screen and enroll all network providers including Children’s Health Insurance Program (CHIP) providers by December 31, 2017. To meet this requirement and continue receiving reimbursement for services, providers who currently render services to CHIP members through (Texas Children’s Health Plan) must complete enrollment with the Texas Medicaid & Healthcare Partnership (TMHP) by December 31, 2017. While the enrollment process and application are the same for Medicaid and...

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Provider Alert!
18May

Provider Alert! STAR Kids Billing Matrix

Attention STAR Kids Providers Effective 06/05/2017 Updated STAR Kids Billing Matrix The STAR Kids billing matrix has been updated to include the registered nurse modifier (TD) to the private duty nursing (PDN) billing code, T1000. Additionally, the billing codes for PDN independently enrolled LVNs and RNs have been added to the matrix. The Revenue Code 663 was added to the Out-of-Home Respite codes. This billing matrix will become effective for dates of service June 5, 2017 and forward. Failure to use this...

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17May

Provider Alert! Authorization Extension for STAR Kids Members

Attention STAR Kids Providers May 17, 2017 Authorization Extension for STAR Kids Members The Health and Human Services Commission expects managed care organizations to extend long term services and supports (such as Personal Care Services, Community First Choice, and Private Duty Nursing) authorizations for services until completion of the STAR Kids Screening and Assessment Instrument (SAI), but no longer than July 1, 2017. In order to receive payment for these services, you must have authorization from Texas Children’s Health Plan, and the SAI must be completed by...

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01May

Provider Alert! Screening for Maternal Depression – Essential to Child Well-Being

Effective January 1, 2017, Texas Children’s Health Plan will reimburse providers for maternal depression screening conducted at a well-child visit. Postpartum depression screening utilizing the Edinburgh Postnatal Depression Scale may be reimbursed up to 2 times per member ages 0-6 months, using CPT code 96161. Code 96161 is used to report the use of a standardized instrument to screen for health risks in the caregiver for the benefit of the patient. The reimbursement for this code will be based on...

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Provider Alert!
15Apr

Provider Alert! STAR Kids Prescription/Pharmacy Prior Authorizations Reinstated 4/15/17

PRESCRIPTION PRIOR AUTHORIZATION NOTIFICATION Subject: STAR Kids Prescription/Pharmacy Prior Authorizations Reinstated 4/15/17 Effective 4/15/17, Texas Children’s Health Plan (TCHP) will enforce pharmacy prior authorization (PA) requirements for STAR Kids members STAR Kids members who received a prescription between 11/1/16-4/15/17 were not subject to normal PA requirements. PA requirements were temporarily lifted during this period to help facilitate the transition to STAR Kids. After 4/15/17, all prescriptions for STAR Kids members will be subject to normal PA documentation, including non-preferred drugs and drugs that require...

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Provider Alert!
23Mar

Provider Alert! Prior Authorization Changes Coming

Attention: All TCHP Providers Subject: TCHP Prior Authorizations TCHP will be updating the services requiring a prior authorization effective April 1, 2017. Please note there are some key changes to make providers aware of. Physical Therapy, Occupational Therapy and Speech Therapy re-evaluations will no longer need to be prior authorized. The CPT codes for these services are: 97164, 97168, S9152 Spinraza(Nusinersen) has been added as a Medical Benefit by TMHP. Spinraza(Nusinersen) will require a prior authorization. TCHP will follow TMHP coding guidance located at http://www.tmhp.com/News_Items/2017/03-Mar/03-03-%2017%20Billing%20Process%20Reminder%20for%20Spinraza%20nusinersen.pdf A new TCHP prior...

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Provider Alert!
21Mar

Provider Alert! Epaned (enalapril oral solution)

Attention: Texas Children Health Plan Providers  Subject: Epaned The manufacturer of enalapril oral solution (Epaned) changed the formulation from a powder for reconstitution to a prepared oral solution. The powder for reconstitution has been discontinued and the oral solution is not yet on the Texas VDP formulary. VDP is currently reviewing the new formulation to be added to the Texas VDP formulary. Until this issue is resolved, options for providers are: Find a pharmacy with the old Epaned (enalapril oral solution) product in...

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