Monthly Archives - October 2020

Provider Alert!

Provider Alert! 2021 Evaluation and Management (E/M) Guideline Changes

Attention:  All Providers Effective Date: January 1, 2021 Call to action: Evaluation and Management (E/M) Guidelines for new and established patient office visits and other outpatient services have gone through substantial revisions by the American Medical Association (AMA) and the Centers for Medicare & Medicaid Services (CMS). These changes are effective on January 1, 2021 and only affect the new and established patient office visits and outpatient codes (CPT 99201 – 99215). Code 99201 will be eliminated. The History and Physical Examination are no longer elements...

Provider Alert!

Provider Alert! Annual Electronic Visit Verification (EVV) Training Webinar

Attention: Current Electronic Visit Verification (EVV) Users Effective Date: 10/29/2020 Call to action: The webinar is for program providers currently required to use electronic visit verification by state law. Attending the webinar helps complete annual EVV policy and EVV Portal training requirements. There will also be a live question and answer session. The training is on November 13, 2020 at 8:30 a.m. – 12:30 p.m. How this impacts providers: Effective August 1, 2020, the Health and Human Services Commission (HHSC) Electronic Visit Verification...

Provider Alert!

Provider Alert! Prior Authorization Guideline updates for TMJ and Skilled Nursing Facility

Attention: All Providers Effective Date: August 25, 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) would like to inform you of recent updates to the prior authorization requirements and the effective dates. The following codes for each service now...

Provider Alert!

Provider Alert! Subject: Codes: K0108, A9900, and E1399 Wheelchair Guideline

Attention: All Providers Effective Date: October 22, 2020; March 1, 2021 for information pertaining to Code A9900 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. In follow-up to our Provider Alert posted on 7/13/2020 regarding wheelchair accessories, Texas Children’s Health Plan did not implement changes to the current process...

Provider Alert!

Provider Alert! Texas Children’s Health Plan Special Investigations Unit and Claims Payment Review Information

Attention: All Providers Effective Date: October 23, 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) would like to share information with our provider network on two important topics, the Special Investigation Unit and Claims Payment Reviews. What is the Special...

Provider Alert!

Provider Alert! New prior authorization requirements for Teprotumumab-trbw (Tepezza)

Attention: Ophthalmologists and Endocrinologists Effective Date: January 19, 2021 Call to action: Texas Children’s Health Plan (TCHP) is aligning prior authorization criteria for teprotumumab-trbw (Tepezza), J3241 (formerly procedure code C9061), with the Texas Medicaid Provider Procedures Manual (TMPPM). Tepezza is a clinician administered drug indicated for members with thyroid eye disease (TED). Below are the new prior authorization criteria for TCHP members effective 1/19/2021. For initial therapy, ALL of the following criteria must be met: A diagnosis of Graves’ disease (diagnosis code...

Provider Alert!

Provider Alert! October Webinars for Healthy Texas Women Plus

Attention: Primary Care and Obstetric Care Providers 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 invite network providers to webinars hosted by the Health and Human Services Commission (HHSC) promoting the new Healthy Texas Women Plus...

Provider Alert!

Provider Alert! This season a flu vaccine is more important than ever

Date: October 4, 2021 Attention: Primary Care Providers Flu season is upon us, and while it is not possible to say what will happen this fall and winter, the Center for Disease Control (CDC) believes we might have an early and possibly severe season due to reduced population immunity since last March. For this reason, it’s more important than ever we vaccinate ourselves and our patients to avoid serious complications from the flu and to prevent unnecessary medical visits and hospitalizations, which...

Provider Alert!

Provider Alert! Online Learning Opportunity: Pediatric Brain Health Summit on November 5-6, 2020

Attention: Primary Care Providers, Neurologists, Early Childhood Specialists, and relevant providers 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 inform providers that the 2020 Pediatric Brain Health Summit is being held online November 5-6, 2020. The...

Provider Alert! Texas Children’s Health Plan to host live CME Event

Paying Attention to ADHD: Diagnosis, Treatment & Resources  Texas Children’s Health Plan is hosting a new CME: Paying Attention to ADHD: Diagnosis, Treatment & Resources. This is a free CME for contracted family practice and pediatric providers that will offer two course credits   Thursday, October 29, 2020 – 5:30-7:30 p.m. – Live stream via WebEx   Topics covered will include: Diagnosis and treatment of ADHD Community supports & resources Pharmacy navigation with the state formulary What is CPAN (The...