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 require a prior authorization:
For TMJ related services:
21031 21032 21050 21100 21110 21120 21121 21122 21123 21125 21127 21137 21138 21139 21141 21142 21143 21145 21146 21147 21150 21151 21154 21155 21159 21160 21172 21175 21179 21180 21181 21182 21183 21184 21188 21198 21199 21206 21208 21209 21210 21215 21230 21235 21244 21256 21260 21261 21263 21267 21268 21270 21275 21295 21296 21299 40840 40842 40843 40844 40845
For Skilled Nursing Facility services:
99304 99305 99306 99307 99308 99309 99310 99315 99316 99318
How this impacts providers: Providers should follow the new prior authorization guidelines and submit the requests for coverage timely to ensure payment. The turnaround time for routine requests is three business days.
Next steps for providers: Providers should inform their staff of the new prior authorization requirements.
If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.
For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.
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