Tag - reimbursement

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! Updated reimbursement information for Inpatient Genetic Services

Attention: Geneticist Effective Date: May 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: TCHP would like to inform you of a recent update to the reimbursement information for inpatient genetic service codes 99254 and 99255. Effective for dates of service on or [...]

Provider Alert! UPDATE ALERT #3 –Telehealth Services – PT/OT/ST; FQHC/RHC Providers and COVID-19

Attention: All Providers Effective Date: March 31, 2020 Providers should monitor the Texas Children’s Health Plan 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) supports the delivery of telehealth (non-physician-delivered) distant site services to its members, and we have implemented special waiver provisions for its use during this [...]

Provider Alert!

Provider Alert! Reimbursement Rate Changes for PCS, PDN & Therapy Services

Date: October 16, 2019 Attention: Home Health, Therapy and LTSS Providers Subject: Reimbursement Rate Changes for PCS, PDN & Therapy Services Effective Date: September 1, 2019 Call to action: On August 28, 2019, Texas Children’s Health Plan (TCHP) received notice of the rate changes from Texas Medicaid Healthcare Partnership (TMHP) effective September 1, 2019.  The services impacted by the Medicaid-implemented rate changes include: Personal Care Services (PCS) Private Duty Nursing (PDN) Therapies for Children in the Home Therapy Assistants TCHP is in the process of implementing the updates [...]

Provider Alert!

Provider Alert! Physician services provided in outpatient hospital settings

Effective October 1, 2019, physician services furnished in outpatient hospital settings that are ordinarily provided in a physician office will be reimbursed at a rate of 60% of the Texas Medicaid rate as outlined in Section 9.5.3 Reimbursement of the Texas Medicaid Provider Procedures Manual (TMPPM). Providers should verify impacted procedures and Place of Service (POS) codes to determine appropriate payment for covered services. The applicable procedure codes for those services include, but are not limited to: 99201-99205, 99211-99215, and [...]

Provider Alert!

Provider Alert! Update: Reimbursement Code for Sports and Camp Physicals

As spring training and sports begin, it’s an ideal time to ensure that all members are receiving their Texas Health Steps check ups timely. Texas Children’s Health Plan wants to remind our pediatric providers about sports physicals as value-added services. Members aged 5 - 19 (STAR & CHIP), 5 – 20 (STAR Kids) who have had a Texas Health Steps check up in the last 12 months will be eligible for one annual sports and school physical delivered by their [...]

Telemedicine and Telehealth Webinar

On October 26, 2018, TMHP will host a live webinar to present a high-level overview of Telemedicine and Telehealth services and resources available to providers. Topics covered in the webinar will include: Reimbursements Places of service Provider Types Procedure codes and modifiers Documentation requirements Resources The Telemedicine and Telehealth Services webinar will introduce providers to information and reference materials that can improve their experience with Medicaid. Follow the link below to register: https://register.gotowebinar.com/register/8794348491023185667 After registering, a confirmation email will be sent with information about joining the webinar.  For more information, [...]

Reimbursement code for sports and camp physicals

Effective January 1, 2017, Texas Children’s Health Plan began reimbursing code 97169 – Athletic Training Evaluation, low complexity, as a value added service to CHIP and STAR Members under 21. This code is only reimbursed for sports and camp physicals when a member has also had a THSteps or well child visit within the previous 12 months. Code 97169 will be the only code that is accepted for reimbursement; use of any other Athletic Training Evaluation code (such as [...]

SBIRT: A validated practice to recognize teens who need help for substance abuse is a benefit of Texas Medicaid

A recent survey of pediatricians found that only a minority of pediatricians used validated screening tools for substance abuse screening, and most relied on clinical impressions. Studies have found that only one-third of adolescents excessively using alcohol were detected when pediatricians relied on clinical impressions. A revised policy statement and a new clinical report from the American Academy of Pediatrics (see additional resources below) contain updated guidance, including screening tools and intervention procedures in support of universal Screening, Brief [...]