Monthly Archives - June 2018

Preferred lab provider: Quest Diagnostics

As you know, Texas Children’s Health Plan entered into an agreement with Quest Diagnostics to serve as our exclusive reference lab provider, effective January 1, 2015. Per state regulations, laboratory specimens that are required to be sent to state laboratories for processing will continue to follow guidelines provided in the Texas Medicaid Provider Procedures Manual (TMPPM). If you do not currently have a relationship with Quest Diagnostics, you will be contacted by a Texas Children’s Health Plan or Quest Diagnostics representative to...

Hospital – Facility Billing Neonatal Claims Must Submit Application for Neonatal Level of Designation before July 1, 2018

Attention:  All Hospitals Subject:  Hospitals Billing Neonatal Claims Must Submit Application for Neonatal Level of Designation before July 1, 2018 Effective immediately, hospitals rendering neonatal services must submit their neonatal designation applications to the Texas Department of State Health Services. Completed applications must be submitted before July 1, 2018. Applications received after July 1 will not be considered for approval. If an application is received after July 1, it will not be considered as submitted in time for approval by the executive commissioner before...

Save the Date: September 13 CME Disparities in Care

Grand Rounds CME Series:  Disparities in Care September 13, 2018 Event will be broadcasted. Additional event information to come. Stay up-to-date by checking Provided by Texas Children’s Hospital and presented by Texas Children’s Health Plan

Provider Alert!

Provider Alert! Services for Priority Populations with Substance Use Disorder

Attention:  Behavioral Health & OB/GYN Providers Subject:  Services for Priority Populations with Substance Use Disorder   The Texas Health and Human Services is committed to providing services for people with substance use disorders. Pregnant women and women with dependent children are identified as priority populations to receive services funded through the Substance Abuse Prevention and Treatment Block Grant. To find out more please visit Texas Health and Human Services at

Provider Alert!

Provider Alert! OB Provider Incentive Program Updates

Attention:  OB Provider Groups Subject:  OB Provider Incentive Program Updates   Texas Children’s Health Plan (TCHP) is pleased to announce the updated OB Provider Incentive Program. The purpose of the program is to continue rewarding the OB provider groups for providing quality care to our members during their pregnancy, from early prenatal care to delivery and timely postpartum care.   Attached is the OB Provider Incentive Program brochure for your review. TCHP will host a webinar (12:00pm-1:00pm, June 21st, 2018) to explain the structure of...

Prescription medications and photosensitivity

Summertime means more time spent in the sun, so it is important to remind your patients of the risk of increased photosensitivity when taking certain prescription medications. Photosensitivity is particularly common in two classes of prescription drugs: acne medications and antibiotics. The prescription information your patients receive will warn them of the risk, but it is also key for you to advise your patients about this potential side effect. When prescribing one of these medications, recommend that your patients either...

New vision services provider: Envolve Vision

Effective April 1, 2018, Envolve Vision will provide routine vision services for all members. If you have any questions about vision benefits, please call Envolve Vision. The following toll-free numbers apply to both providers and members. CHIP: 1-844-520-3711 STAR: 1-844-683-2305 STAR Kids: 1-844-212-7269

Provider Alert!

Provider Alert! Physician Incentive Program Payment Delay

Attention: Primary Care Physician Groups Subject: Physician Incentive Program Payment Delay We are very sorry to inform you that our Physician Incentive Program payment, targeting Well- Child Visits in the First 15 Months of Life, has been delayed. We apologize for any inconvenience that this delay may cause.The data for Well-Child Visits in the First 15 Months of Life is being reviewed and validated by a certified vendor. We anticipate being able to deliver the EOP and payment in early July, and will send...

Be a HEDIS hero

The National Committee for Quality Assurance (NCQA) is a non-profit organization that measures the quality of healthcare across large populations. NCQA does this through its Health Effectiveness and Data Set, also known as HEDIS. HEDIS measures are a set of evidence-based standards that Texas Children’s Health Plan is committed to improving upon in order to provide the best care for our members. Making changes across your patient population is easier than you think! In fact, you can become a HEDIS hero...