Tag - provider alert

Provider Alert!
01Mar

Provider Alert! LTSS Provider Claims Request

Attention Long Term Services and Supports Providers Texas Children’s Health Plan would like to ensure that we have received all your claims from November 1st 2016, the program start date for STAR Kids. If you should have any questions related to claim submission and/or billing requirements, please contact Provider Relations at 1-800-731-8527. Your  Provider Relations team is prepared to guide you through the billing standards necessary to accurately bill Texas Children’s Health Plan and receive your payments timely. The Texas Children’s Health Plan...

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Provider Alert!
02Feb

Provider Alert! Prior Authorization required on all Vendor Drug Program (VDP) identified medications

Attention: Star Kids Providers Subject: Reminder: Prior Authorization required on all Vendor Drug Program (VDP) identified medications Texas Children’s Health Plan requires prior authorization (PA) on certain medications per the VDP website prior to dispensing to members. To obtain a list of medications requiring prior authorization, visit the VDP website at: http://www.txvendordrug.com/formulary/preferred-drugs.shtml Providers can also view instructions on accessing and using the formulary at the Texas Children’s Health Plan website: http://www.thecheckup.org/2016/06/09/do-you-know-how-to-access-the-texas-childrens-healthplan-formulary/ Providers can submit PA documentation to Texas Children’s Health Plan’s pharmacy benefit manager, Navitus....

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Provider Alert!
01Feb

Provider Alert! Reminder on ability to bank respite hours for MDCP members

Attention: All STAR Kids Providers February 1st 2017 Subject: Reminder on ability to bank respite hours for MDCP members Texas Children’s Health Plan would like to remind all STAR Kids providers who are providing respite care to members of the standards around respite care hours and how Texas Children’s Health Plan manages these hours. The information below is directly from HHSC and is the guidance Texas Children’s Health Plan follows for determining respite care. Please always contact either Texas Children’ Health Plan’s...

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07Dec

Provider Alert! Health Advisory Issued on Mumps Outbreaks in Texas

The Texas Department of State Health Services issued a Health Advisory on 11/30/2016 due to two outbreaks of mumps in North Central Texas. An outbreak in Dallas County involves 5 adults and a Johnson City outbreak involves 10 cases, mostly in children. Several other outbreaks have occurred in the US outside of Texas. DSHS requests that physicians "please consider mumps as a diagnosis for any patients presenting with the following symptoms, particularly those who have traveled out of the state or have...

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05May

Provider Alert! Reminder on the use of the U8 Modifier

To: All Texas Children’s Health Plan Providers Subject: Reminder on the use of the U8 Modifier All eligible organizations and covered entities that are enrolled in the Federal 340B Drug Pricing Program to purchase 340B discounted drugs must use modifier U8 when submitting claims for 340B clinician-administered drugs. Non-compliance with this new requirement to use modifier U8 on all claims submitted for 340B clinician-administered drugs may jeopardize a covered entity’s 340B status with the U.S. Department of Health and Human Services Health Resources...

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21Jan

Provider Alert! Annual Reminder on Copayments and Deductibles

To:  All Texas Children’s Health Plan Providers Subject: Annual Reminder on Copayments and Deductibles Texas Children’s Health Plan will pay for a primary insurance deductible with proof of assignment to the deductible on the primary evidence of procedure. Payments will be made up to Medicaid allowable only. Claims for primary insurance copayments should be sent to Texas Medicaid and Healthcare Partnership directly.  Texas Children’s Health Plan will not pay CP001 or CP002 on a claim as these are not payable by the managed...

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23Dec

Provider Alert! Long Acting Reversible Contraception (LARC) Billing Changes

To: All Providers and Facilities Subject: Long Acting Reversible Contraception (LARC) Billing Changes Recent changes at Health and Human Services Commission (HHSC) has improved the accessibility of LARC devices for Medicaid members. HHSC is currently working to add ParaGard, Nexplanon and Liletta to the Medicaid Vendor Drug Program formulary. More information on these products and the process to order will be supplied as these are added. Once added, providers may choose to continue to “buy and bill” or they may choose to...

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01Sep

Provider Alert! Preventing Pre-Term Pregnancies

To: All Providers Subject: Effective September 1, 2015 all Progesterone therapy will require a pre-authorization from Texas Children’s Health Plan. Claims billed using the branded Makena will no longer require a U1 modifier. Pre-authorized use of Makena (hydroxyprogesterone caproate injection) will need to be submitted as J1725 with the appropriate NDC information as required on all claims. Claims billed using the compounded 17-P therapy will now require the U1 modifier. Pre-authorized use of 17-P will need to be submitted as J1725 with the...

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