Monthly Archives - April 2018

Provider Alert!

Provider Alert! CHIP Member Eligibility Now Available via EDI HIPAA 270/271 Transaction

Attention:  CHIP Providers and Submitters RE: CHIP Member Eligibility Now Available via EDI HIPAA X12 270/271 Transaction Note: This applies only to CHIP providers and submitters. No action is required for Medicaid providers or submitters. Available immediately, CHIP providers and submitters wishing to request and receive CHIP member eligibility using HIPAA X12 270/271 transactions may begin utilizing a new eligibility system. CHIP providers and Electronic Data Interchange (EDI) submitters may begin the Trading Partner Testing process by contacting TMHP at to receive...

ADHD Provider Tool Kit:  Treatment

What is it? The ADHD Provider Tool Kit is the online Texas Children’s Health Plan resource for a wide range of relevant information to assist the diagnosis, treatment, and management of patients with ADHD and their families. The goal is to provide information sources for providers who frequently see patients with this diagnosis. Treatment planning The Tool Kit includes algorithms for providers to help ensure a thoughtful and well-rounded treatment plan for members with ADHD. Interventions for patients and their caregivers as well...

Practitioner Statement of Need (PSON)

Before an assessment for PAS, PCS, and/or HAB for a Texas Children’s Health Plan member can take place, Texas Children’s Health Plan must receive a Practitioner Statement of Need (PSON) signed by a practitioner (physician, advanced practice nurse, or physician assistant) who has examined the member in the last 12 months and reviewed all relevant medical records. After the assessment, the provider will receive information regarding the number of provider hours (if any) to be authorized for the member, as...

Provider Alert!

Provider Alert! Therapy Modifiers

Therapy modifiers A modifier must be used to indicate when treatment services have been rendered by a licensed therapist/ physician or a therapy assistant under supervision of a licensed therapist. The following modifiers are not required for evaluation or re-evaluation codes because those services may not be rendered by therapy assistants. UB – Services delivered by a licensed therapy assistant under supervision of a licensed therapist. U5 – Services delivered by a licensed therapist or physician. Claims for co-treatment services must be submitted with modifier...

Asthma QI Project Opportunity

Participation in an American Academy of Pediatrics Chapter Quality Network initiative focused on improving Asthma is available to TCHP Houston providers.  The link below includes details on the MOC Parts II and IV and CME PI credit that can be earned. Heidi Schwarzwald MD MPH CMO Pediatrics, Texas Children’s Health Plan Associate Vice Chair Community Health Department of Pediatrics Baylor College of Medicine

Texas Pediatric Society Sponsors MOC Qualified Project: Improving Pediatric Asthma Care in Texas

The Texas Pediatric Society and American Academy of Pediatrics are helping pediatric practices in Houston with an asthma quality improvement project that qualifies for American Board of Pediatrics Maintenance of Certification (MOC) Part 2 and Part 4 credit. If you are interested in finding out more about this exciting project and/or considering participation, contact Kellie Dees at the Texas Pediatric Society. Her email is Act now! The deadline to enroll is April 25, 2018.

Provider Alert!

Provider Alert! TCHP Prior Authorization Requirement

Subject: TCHP Prior Authorization Requirement Effective April 1, 2018, TCHP will be updating the prior authorization listing. This notice will serve as your 90-day advance notification of the change. Please note there are some key changes for providers. Removed from the list and will no longer require prior authorization: Walkers Vision Care, medically necessary New to the list: High cost injectable drugs (>$75K per dose) in an outpatient level of care require prior authorization. Examples include: Kymriah, Spinraza, Exondys Updates: Progesterone therapy has been updated to Hydroxyprogesterone caproate injections. Transplant...

Provider Notification: Credentialing Using Availity

Date: 04/01/18 Texas Children’s Health Plan is now using Availity, a credentialing application portal, for implementation of the Credentialing Verification Organization (CVO). On April 12, a webinar training will be offered to providers to instruct on the new credentialing process using he Availity portal. This training is for providers who have already registered with Availity, and will be an in-depth training on how to use the Credentialing tool. Instructions to Enroll in Training Webinar:  To enroll for the Credentialing on the Availity Portal webinar training on...