Tag - reimbursement

Provider Alert!
22Mar

Provider Alert! UPDATED: Notification of CORF/ORF Reimbursement Policy

Date: March 22, 2024 Attention: Comprehensive Outpatient Rehabilitation Facility (CORF) and Outpatient Rehabilitation Facility (ORF) Providers Effective Date: June 1, 2024 Call to action: The purpose of this communication is to make providers aware of a new reimbursement policy for Texas Children’s Health Plan (TCHP), which outlines the billing requirements for Comprehensive Outpatient Rehabilitation Facility (CORF) and Outpatient Rehabilitation Facility (ORF) provider types. This policy applies to CHIP and Medicaid lines of business. This policy does not apply to ECI, Home Health, Individual...

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Provider Alert!
29Feb

Provider Alert! Notification of Observation/Treatment Room and E&M Services Reimbursement Policy

Date: February 29, 2024 Attention: Hospital facilities Effective Date: May 27, 2024 Call to action: The purpose of this communication is to make hospital facilities aware of a new reimbursement policy for Texas Children’s Health Plan (TCHP), which outlines the billing restrictions for observation and treatment room revenue codes billed with evaluation and management (E&M) services.  This policy applies to hospitals billing outpatient services, and applies to CHIP and Medicaid lines of business. How this impacts providers: Policy guidelines are as follows:Observation and treatment...

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Provider Alert!
03Jan

Provider Alert! Rate Changes for Ambulatory Surgical Centers

Date: January 3, 2024 Attention: Ambulatory Surgical Centers (ASCs) Effective: June 1, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to notify providers that Texas Health and Human Services Commission (HHSC) revised fee-for-service reimbursement rates for Ambulatory Surgical Centers (ASCs) and Hospital ASCs effective June 1, 2023. These rate revisions shift from the group rate and locality code method of payment for each procedure code and instead assigns fees by procedure code. How this impacts providers: TCHP is reprocessing affected claims submitted with...

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Provider Alert!
29Sep

Provider Alert! HHSC Adopts Proposed Payment Rates for Attendant Services in Various Programs

Date: September 28, 2023 Attention: Providers of the programs referenced in this notice Effective date: September 1, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective for dates of service on or after September 1, 2023, reimbursement rate changes and updates for procedure codes presented at a public rate hearing on July 11, 2023, will be implemented. The adopted payment rates, effective September 1, 2023, can be accessed on the Provider Finance Department (PFD) webpage. The following...

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13Jul

Provider Alert! Reimbursement for COVID-19 Vaccines for FQHCs and RHCs Reminder

Date: July 13, 2023 Attention: FQHC and RHC Providers End date for vaccine procedure codes: May 12, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to remind FQHC and RHC providers of the guidance from Texas Medicaid and Healthcare Partnership (TMHP) on COVID-19 vaccine procedure codes. Effective for dates of service on or after May 12, 2023, claims submitted by federally qualified health centers (FQHCs) and rural health clinics (RHCs) for the administration of COVID-19 vaccines will no longer be...

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Provider Alert!
15Feb

Provider Alert! Reimbursement Update for Procedure Codes Pending a Rate Hearing

Date: February 14, 2023  Attention: All Providers Effective date: May 8, 2023 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 May 8, 2023, TCHP will follow the Texas Medicaid Provider Procedures Manual (TMPPM) guidance regarding claims and the procedure codes that are pending a rate...

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Provider Alert!
09Feb

Provider Alert! Orthotics/Prosthetics Services Billed by Podiatrist

Date: February 9, 2023 Attention: Podiatrist Providers Effective date: May 9, 2023 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 May 9, 2023 and in accordance with Texas Medicaid reimbursement guidelines, TCHP will no longer reimburse podiatry providers for orthotic/prosthetic services. This reimbursement policy aligns...

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Provider Alert!
08Dec

Provider Alert! Inpatient Prepayment Review Program

Date: December 6, 2022 Attention: Hospital Providers and Inpatient Facilities 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 purpose of this communication is to address some of the questions we have been receiving related to prepayment claims reviews.  Texas Children’s Health Plan (TCHP)...

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22Nov

Provider Alert! COVID-19 UPDATE ALERT #4 – Telemedicine Services – Physicians, BH, FQHC and RHC Providers

Date: November 21, 2022 Attention: All providers Effective Date: October 25, 2022    The content in this message on Federally Qualified Health Centers (FQHC) reimbursement for Telemedicine (Physician Delivered) and Telehealth (Non-Physician Delivered) Services as a distant site provider as permanent policy change (per S.B. 670, Texas Legislature, Regular session 2019) ended November 30, 2020 as announced by the Health and Human Services Commission. The content in this message on Rural Health Clinics as telehealth and telemedicine sites will remain in effect through March...

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Provider Alert!
06Oct

Provider Alert! Case Management for Children and Pregnant Women (CPW) Carve-In

Date: October 5, 2022 Attention: All Providers Effective date: September 1, 2022 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 purpose of this communication is to inform our providers of the Case Management for Children & Pregnant Women (CPW) carve-in to Medicaid that became...

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