Tag - reimbursement

Provider Alert!
13Jul

Provider Alert! Update to “Correction to Reimbursement Rate Changes and Updates for Texas Medicaid Procedure Codes”

Date: July 7, 2022 Attention: Behavioral Health Providers Effective date: March 1, 2022 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated with 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: Behavioral health providers should note an update in the reimbursement rates for substance abuse disorder codes H0050 and T1007, effective for dates of...

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27Apr

Provider Alert! COVID-19 Procedure Code S8301 Reimbursement Documentation Reminder

Date: April 25, 2022 Attention: All Providers Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated with 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. TCHP will apply updates and reprocess impacted claims as soon as possible. However, please allow up to sixty (60) business days for reprocessing. Providers are not required to appeal claims unless denied...

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Provider Alert!
18Nov

Provider Alert! JW Modifier Update

Date: November 18, 2021 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...

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Provider Alert!
02Jul

Provider Alert! Reimbursement and Audit Notification on Surgical Procedure Codes (last updated July 1, 2021)

Date: July 1, 2021 Attention: All Providers Subject: 2021-2022 Reimbursement and Audit Notification on Surgical Procedure Codes (last updated July 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) would like to provide information to providers that TCHP follows the...

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Provider Alert!
24Mar

Provider Alert! Update to Renal Dialysis Revenue Codes Eligible for Reimbursement

Date: March 24, 2021 Attention: PCPs and Nephrologists Effective Date: March 23, 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 make network providers aware of updates for some of the renal dialysis revenue codes. How this impacts providers:...

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Provider Alert!
12Jun

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 after...

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31Mar

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 disaster...

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Provider Alert!
16Oct

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 in...

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Provider Alert!
01Oct

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 99281-99283. Next...

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Provider Alert!
18Mar

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 Primary...

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