Monthly Archives - August 2018
20Aug

Upcoming Changes to Prior Authorization for Antipsychotic Medications

Effective September 1, 2018, the prior authorization for antipsychotic medications will change. At the May 15th Texas Association of Community Health Plans P&T Committee meeting, the Texas Managed Care Organizations, supported by Navitus, voted by majority to modify the Antipsychotic Clinical Prior Authorization Edit in compliance with the guidelines set forth by the Health and Human Services Commission Vendor Drug Program. The health plans opted to remove the requirements for diagnoses, while maintaining criteria for age and duplicate therapy in...

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14Aug

Modifier Change for Dental General Anesthesia

Note: Texas Medicaid managed care organizations must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, pre-certification, referrals and claims/encounter data filing may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the client's specific MCO for details. Pending final approval of the Nov. 16, 2017 rate hearing adjustments, the modifier to be submitted with services related to dental general anesthesia will change for Texas Medicaid. This change will be effective...

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10Aug

Medication Synchronization Plan

Effective September 1, 2018, Texas Children’s Health Plan members can receive the Medication Synchronization benefit that will allow them to pick up all of their prescription medication refills on a single day each month, rather than having to go to the pharmacy multiple times per month. The coordination of refills is proven to lead to better adherence to medication regimens. Inform your patients about this exciting new option. Taking advantage of the Medication Synchronization benefit is as simple as the patient...

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05Aug

Provider Alert! Reminder: Authorization Requirements and Code Configuration

As a reminder, Texas Children’s Health Plan continues to require authorization for the following service categories: Bariatric surgery Circumcision in children 1 year of age and older General anesthesia for dental procedures for children 6 years and under (STAR and STAR Kids only) Oral surgery and medically necessary dental procedures Therapeutic and reconstructive breast procedures (including breast prosthesis) TMJ diagnosis and treatment Transplant services Providers will be able to access a complete list of codes that require an authorization in these categories on the Texas Children’s Health Plan...

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01Aug

Clarification in Limitations of Allergen Immunotherapy

Based on recommendations of network providers, the immunotherapy preparation (CPT 95165) benefit has been modified to allow 80 units in 6 months. This will facilitate ease of payment for initial preparation of antigen mixture for new patients and is consistent with national guidelines. Subsequent to the initial preparation claim, Texas Children’s Health Plan anticipates immunotherapy preparation (CPT 95165) maintenance claims consistent with national guidelines. Billing Use of CPT code 95165, professional services for the supervision and provision of antigens for allergen immunotherapy in...

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