Tag - provider alerts

Provider Alert!
24Jul

Provider Alert! Mandatory HHSC Webinar Training

7/23/2019 Attention: Financial Management Services Agencies (FMSA) HHSC is providing a webinar training for financial management services agencies (FMSAs). All FMSAs currently contracted with MCOs or HHSC must attend this mandatory training. When: Monday, July 29th at 1:30 p.m. Where: Online webinar, Register here: https://register.gotowebinar.com/register/6419407779512242946 What to expect: Consumer Directed Services (CDS) updates and reminders EVV updates   NOTE: Go to https://support.logmeininc.com/gotomeeting/get-ready  to run a test of your computer’s connectivity if you have never attended a Webinar from your computer. You can run this test at any time prior to the date...

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Provider Alert!
02Jul

Provider Alert! TCHP Prior Authorization Requirements

Date:  July 1, 2019 Subject: TCHP Prior Authorization Requirements Effective October 1, 2019, TCHP has updated the prior authorization listing. Please note there are some key changes for providers.   Added:            Case by Case Added Services This category includes CPT/HCPCS codes that are listed as not payable in the TMHP fee schedule. Clinician Administered Drugs that Require Authorization Please refer to the Prior Authorization Reference Information document for specific codes that fall under this category. This document can be found at: https://www.texaschildrenshealthplan.org/for-providers/provider-resources   DME Repair (K0739)...

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Provider Alert!
10Jun

Provider Alert! Reminder: Texas Children’s Health Plan Claims Editing System (CES) Update

Attention:  All Providers Update: Texas Children’s Health Plan Claim Editing System Texas Children’s Health Plan (TCHP) recently sent a Provider Alert updating our plan to transition to a new Claims Editing System (CES) by Optum on May 31, 2019. Please be advised this transition will now include edits specific to Texas and National Medicaid and the transition will occur in June 2019. This was initially scheduled to be done later in the year as another phase of the project, however we...

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Provider Alert!
14May

Provider Alert! Health Insurance Portability and Accountability Act (HIPAA) Compliant Reasons for Denials and Adjustments

Attention:  All Providers Health Insurance Portability and Accountability Act (HIPAA) Compliant Reasons for Denials and Adjustments   Beginning May 15, 2019, Texas Children’s Health Plan (TCHP) providers will see positive changes to their HIPAA standard 835 electronic remittance and paper explanations of payments (EOPs). TCHP will be providing more robust and HIPAA compliant messages by utilizing national standard claim adjustment reason codes (CARCs) and remittance advice remark codes (RARCs). What are CARCs and RARCs? CARCs and RARCs are industry standard code sets used to explain...

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Provider Alert!
30Apr

Provider Alert! Texas Children’s Health Plan Claim Editing System Update

Attention:  All Providers Reminder: Texas Children’s Health Plan Claim Editing System Update   Texas Children’s Health Plan (TCHP) previously sent a Provider Alert notifying providers that an intended transition to a new Claims Editing System (CES) by Optum was to occur in December 2018. Please be advised that this transition will now be occurring May 31, 2019.  Any claims submitted May 31, 2019 and after, including corrected and adjusted claims, will be processed with the Optum CES edits. TCHP is required by Texas Health...

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Provider Alert!
22Apr

Provider Alert! Governor Greg Abbott Issues Disaster Declaration for Cherokee, Freestone, Houston, Leon, Madison, Nacogdoches, Robertson, San Augustine, and Shelby Counties.

On April 18, 2019: Governor Greg Abbott issued a disaster declaration for the following counties Cherokee, Freestone, Houston, Leon, Madison, Nacogdoches, Robertson, San Augustine, and Shelby counties. If a member resides in one of these impacted areas named above Texas Children’s Health Plan will make every effort to assist them in obtaining medically necessary services. PHARMACY: Navitus Pharmacy update related to disaster declaration: Navitus has implemented the "Disaster Declaration and Refill Too Soon" process as a result of the severe weather, including thunderstorms and tornado events...

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Provider Alert!
09Apr

Provider Alert! DME/Supplies Exceeding Medicaid Limitations

Date: 04/09/2019 Subject: DME/Supplies Exceeding Medicaid Limitations Attention: DME and Home Health Providers Texas Children’s Health Plan applies benefit limitations for DME Supplies and Equipment per the current TMHP Manual for all members eligible to receive the benefit. See benefit exceptions below. Frequency of Billing As a reminder, DME monthly limits will be applied every 27 days. Claims for recurring DME rentals and/or monthly disposable supplies billed prior to this renewal date are subject to denial. Denied claims may be appealed through the standard appeal process...

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Provider Alert!
02Mar

Provider Alert! Prior Authorization

Prior authorization alert Effective January 1, 2019, Texas Children’s Health Plan updated the prior authorization listing. Please note there are some key changes for providers. Removed from the list and will no longer require prior authorization: Baclofen Pump New to the list: Home Telemonitoring Updates: Ambulance (non-emergent transport) has been updated to Non-Emergency Ambulance Transport. Augmentative Communication Device has been updated to Augmentative Communication Device and Accessories. Chemotherapy non-FDA approved has been updated to Non-FDA approved medications. Cranial Molding Orthosis (Helmets) has been updated to Cranial Molding Orthosis. High cost (>$50,000) injectable...

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Provider Alert!
13Oct

Provider Alert! Reminder – LTSS Enrollment Deadline Extended to October 31, 2018

Attention:  Long Term Services and Supports Providers (LTSS) Subject:  Reminder - Enrollment Deadline Extended to October 31, 2018   This is a reminder that the enrollment deadline for Long Term Support Services (LTSS) providers serving MCO members is quickly approaching. Long Term Support Services (LTSS) providers serving MCO members are required to enroll through the Medicaid MCO LTSS provider enrollment process.   To allow sufficient time for application processing, MCO LTSS providers are strongly advised to submit applications as soon as possible.   An MCO LTSS Provider...

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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...

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