Provider Alert! Utilization Management COVID-19 Procedure Update

Attention: Therapy, LTSS, Private Duty Nursing, and DME Service Providers       

Effective Dates: December 1, 2020 and March 1, 2021

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 network providers of the following updates made to the Utilization Management (UM) COVID-19 Procedure.

The updates effective December 1, 2020 are as follows:

• Change of provider letter is required for a service provider change
• For missing signatures, in plan of care, etc. providers MUST state “missing signatures, COVID-19” in the request
• Documentation of an office visit note for the acute injury or acute exacerbation of the medical condition will be required for authorization of acute therapy services (ST, OT, PT)
• TCHP may accept prior authorization requests submitted within 7 calendar days of the requested service start date and the request will not be considered retrospective

The updates for March 1, 2021 are as follows:

• Yearly treating physician office visit is required, for private duty nursing prior authorization approval
• Documentation of current Texas Health Steps Checkup is required for speech, physical and occupational therapy prior authorizations

As a reminder, hearing screening requirements remain waived for speech therapy.

How this impacts providers: Providers should follow the updates made to the utilization management procedure and submit the requests for coverage timely to ensure payment.

Next steps for providers: Update their office staff on the new utilization management procedure updates.

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.