Tag - provider alerts

Provider Alert!

Provider Alert! Attention: NCQA HEDIS Measure Changes

Attention: PCP, OB/GYN and Endocrinologist Providers Effective Date: January 1, 2020 Call to action: Texas Children’s Health Plan (TCHP) would like to inform you of changes to the National Committee for Quality Assurance (NCQA) HEDIS Technical Specifications released on July 1st, 2020. How this impacts providers: These changes are effective as of January 1, 2020. REVISED MEASURES Well-Child Visits in the First 30 Months of Life (W30) Revised the measure name and replaces the former W15 measure Added Age 15 Months - 30 Months Two rates will [...]

Provider Alert!

Provider Alert! Single-Dose Vial Unused Portion Reimbursement Policy for Clinician-Administered Drugs

Attention: All Providers Effective Date: September 1, 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: Texas Children’s Health Plan (TCHP) aligns with Texas Medicaid and Healthcare Partnership (TMHP) regarding the reimbursement policy for the unused portion of a single use vial for clinician-administered [...]

Provider Alert!

Provider Alert! Prior Authorization Guideline updates for Private Duty Nursing (PDN) and therapy specialty services

Attention: All Providers Effective Date: July 18, 2020 for PDN and August 11, 2020 for therapy Services 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 would like to inform you of recent updates to the prior authorization requirements and the effective dates. Updates [...]

Provider Alert!

Provider Alert! Uniform Opioid Policy Begins September 1

Attention: All Providers Effective Date: September 1, 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: Effective September 1, 2020, the Vendor Drug Program (VDP) will implement a uniform opioid policy to encourage appropriate use and reduce opioid over-prescribing. The opioid policy does not apply to chronic pain, [...]

Provider Alert!

Provider Alert! Update: Substance Use Disorder (SUD) Services Codes that now require a Prior Authorization: H0050, S9445, and T1007

Attention: Behavioral Health Providers Effective Date: September 23, 2020 for Codes H0050 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) aligns with the prior authorization criteria available in the most recent Texas Medicaid Provider Procedures Manual (TMPPM), Withdrawal Management [...]

Provider Alert!

Provider Alert! Generic Albuterol Products Return to Non-Preferred Status for Medicaid Members

Attention: All Providers Effective Date: August 28, 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: Beginning August 28, 2020 the Texas Vendor Drug Program (VDP) will restore non-preferred status to a number of generic albuterol products. VDP temporarily removed nonpreferred status from these [...]

Provider Alert!

Provider Alert! Preferred Generic Stimulant Available on the TX Medicaid Formulary

table { border-collapse: collapse; } tr,td { border: solid thin; } Attention: All Providers Effective Date: July 30, 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: Effective Thursday, July 30, 2020, the Texas Vendor Drug Program (VDP) updated [...]

Provider Alert!

Provider Alert! Prior authorization update for Reblozyl, procedure code J0896

Attention: Hematologists Effective Date: September 1, 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: Texas Children’s Health Plan (TCHP) will align the prior authorization requirements for Reblozyl with Texas Medicaid Healthcare Partnership (TMHP) guidance. A prior authorization will be required beginning September 1, [...]

Provider Alert! Medicaid, STAR Kids, CHIP, and CHIP Perinatal eligibility during COVID-19

Attention: All providers Effective Date: July 31, 2020 – October 23, 2020 The content in this message will remain in effect through October 23, 2020 as announced by the Health and Human Services Commission (HHSC). TCHP COVID-19 Utilization Management Procedure and provider alerts can be found here: http://www.thecheckup.org/provider-alerts/ 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 [...]

Provider Alert! THSteps Medical and Dental Checkups during COVID-19

Attention: Primary Care Providers Effective Date: July 31, 2020   The content in this message will remain in effect through October 23, 2020 as announced by the Health and Human Services Commission (HHSC). TCHP COVID-19 Utilization Management Procedure and provider alerts can be found here: http://www.thecheckup.org/provider-alerts/ 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 [...]