Tag - provider alert

Provider Alert!
05Mar

Provider Alert! Prior Authorization Changes for Fasenra and Nucala

Date: February 19, 2021 Attention: Allergists & Immunologists, Pulmonologists Effective Date:  April 6, 2021 Call to action: Texas Children’s Health Plan (TCHP) is modifying prior authorization criteria for two monoclonal antibodies available through the pharmacy benefit: Fasenra (benralizumab) and Nucala (mepolizumab). Both are monoclonal antibodies approved for the treatment of severe asthma. The Texas Health and Human Services Commission (HHSC) revised the clinical prior authorization criteria for these agents to enhance appropriate utilization per the US Food and Drug Administration’s (FDA) approved indications and...

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Provider Alert!
26Feb

Provider Alert! Synagis Season Extended for Counties in Southeast Texas and Gulf Coast Areas

Date: February 26, 2021 Attention: All Providers 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: Synagis (palivizumab) is indicated for children with a high risk of infection to respiratory syncytial virus (RSV).  This virus causes respiratory tract infections and severe lung disease in infants and...

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Provider Alert!
18Feb

Provider Alert! CPT Coding for Self-Measured Blood Pressure Monitoring

Date: February 18, 2021 Attention: All providers 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 would like to inform network providers of Current Procedural Terminology (CPT®) Codes available to support self-measured blood pressure monitoring. How this impacts providers: The CPT Codes include...

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Provider Alert!
17Feb

Provider Alert! Transport to and from Shelters

Date: February 17, 2021 Attention: Ambulance Transport Companies Effective Date: February 15, 2021 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: In response to the current weather conditions, effective February 15 through February 19, 2021, Texas Children’s Health Plan will reimburse for ambulance transportation of technology...

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12Feb

Texas Children’s Health Plan to host special live CME event

Eating Disorders and Gynecologic Care for Young Women  Recognize eating disorders and common menstrual problems, and know the resources available for at-risk patients to sex trafficking. This is a free, online CME course for contracted providers of the health plan provided by Texas Children’s Hospital. Thursday, February 25, 2021 – 5:30 p.m. - 7:30 p.m. – Live stream via WebEx Topics covered will include: Eating disorders Amenorrhea Abnormal Uterine Bleeding STIs Contraception Sex Trafficking To register today, click here. For questions, email tchpcme@texaschildrens.org The...

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Provider Alert!
29Jan

Provider Alert! Medicaid drug formulary changes

Date: January 26, 2021 Attention: All Providers Effective Date: January 28, 2021 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 Texas Vendor Drug Program (VDP) will implement changes to the state Medicaid drug formulary, effective Thursday, January 28, 2021. Select medications will be moving from...

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Provider Alert!
28Jan

Provider Alert! Oseni and the Thiazolidinediones (TZD) Clinical Prior Authorization Update

Date: January 26, 2021 Attention: Primary Care Providers and Endocrinologists  Effective Date: February 4, 2021 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 network providers that beginning February 4, 2021 Texas Medicaid will remove the Thiazolidinediones (TZD)...

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Provider Alert!
28Jan

Provider Alert! Dupixent Clinical Prior Authorization Criteria Revision

Date: January 26, 2021 Attention: PCPs, Allergists, Pulmonologists, and Dermatologists Effective Date: March 15, 2021 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 March 15, 2021, Texas Medicaid will revise criteria of the Dupixent (dupilumab) clinical prior authorization. This is only applicable to medications dispensed...

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Provider Alert!
28Jan

Provider Alert! Injectable and Oral Desmopressin Clinical Prior Authorization Update

Date: January 26, 2021 Attention: PCPs, Endocrinologists, and Hematologists Effective Date: March 15, 2021 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 March 15, 2021, Texas Medicaid will revise the injectable and oral desmopressin clinical prior authorizations to remove the denial criterion for hyponatremia. This...

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Provider Alert!
28Jan

Provider Alert! Prior Authorization Criteria for Tecartus Updated January 1, 2021

Date: January 26, 2021 Attention: Oncologists Effective Date: January 1, 2021 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) follows the clinical prior authorization criteria for Tecartus (Procedure Code C9073), presented by the Health and Human Services Commission (HHSC). Tecartus (C9073)...

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