Monthly Archives - January 2021

Provider Alert!
29Jan

Provider Alert! Provider Initiated Termination Process and Requirements

Date: August 13, 2021 Attention: All Providers Effective Date: December 1, 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 network providers of the provider initiated termination process and requirements. A provider may terminate from Texas Children’s...

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Provider Alert!
29Jan

Provider Alert! Medicaid drug formulary changes

Date: January 26, 2021 Attention: All Providers Effective Date: January 28, 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: The Texas Vendor Drug Program (VDP) will implement changes to the state Medicaid drug formulary, effective Thursday, January 28, 2021. Select medications will be moving from...

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Provider Alert!
28Jan

Provider Alert! Oseni and the Thiazolidinediones (TZD) Clinical Prior Authorization Update

Date: January 26, 2021 Attention: Primary Care Providers and Endocrinologists  Effective Date: February 4, 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 that beginning February 4, 2021 Texas Medicaid will remove the Thiazolidinediones (TZD)...

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Provider Alert!
28Jan

Provider Alert! Dupixent Clinical Prior Authorization Criteria Revision

Date: January 26, 2021 Attention: PCPs, Allergists, Pulmonologists, and Dermatologists Effective Date: March 15, 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: Effective March 15, 2021, Texas Medicaid will revise criteria of the Dupixent (dupilumab) clinical prior authorization. This is only applicable to medications dispensed...

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Provider Alert!
28Jan

Provider Alert! Injectable and Oral Desmopressin Clinical Prior Authorization Update

Date: January 26, 2021 Attention: PCPs, Endocrinologists, and Hematologists Effective Date: March 15, 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: Effective March 15, 2021, Texas Medicaid will revise the injectable and oral desmopressin clinical prior authorizations to remove the denial criterion for hyponatremia. This...

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Provider Alert!
28Jan

Provider Alert! Prior Authorization Criteria for Tecartus Updated January 1, 2021

Date: January 26, 2021 Attention: Oncologists Effective Date: January 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) follows the clinical prior authorization criteria for Tecartus (Procedure Code C9073), presented by the Health and Human Services Commission (HHSC). Tecartus (C9073)...

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Provider Alert!
28Jan

Provider Alert! Prior Authorization Criteria for Uplizna

Date: January 19, 2021 Attention: All Providers Effective Date: January 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 would like to inform network providers that the Health and Human Services Commission (HHSC) has added Texas Medicaid and CHIP prior authorization...

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Provider Alert!
28Jan

Provider Alert! Evrsydi available on Medicaid formulary with prior authorization requirements on Feb 1

Date: January 25, 2021 Attention: Neurologists and SMA specialists Effective Date: February 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: Prescribers should be aware that Evrysdi will be available to members through Texas Medicaid pharmacy benefit effective February 1. Access will require meeting clinical prior authorization criteria for Evrysdi (risdiplam).  Evrysdi is indicated for treatment...

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26Jan

Provider Alert! Medicaid, STAR Kids, CHIP, and CHIP Perinatal eligibility during COVID-19

Date: July 23, 2021 Attention: All providers Subject: Medicaid, STAR Kids, CHIP, and CHIP Perinatal eligibility during COVID-19 Effective Date: July 22, 2021 For STAR Kids Age Outs that complete their transitions August 1, 2021. The content in this message on STAR Kids Age-Outs that transitioned on April 1, 2020 will remain in effect through July 31, 2021. Individuals ageing out starting May 1, 2021 are following normal timelines and processes, as announced by the Health and Human Services Commission. TCHP COVID-19 Utilization Management Procedure...

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Provider Alert!
26Jan

Provider Alert! Immobilized Lipase Cartridges to Become a Benefit of Texas Medicaid

Attention: All Providers Effective Date: 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 that effective for dates of service on or after March 1, 2021, immobilized lipase cartridges (procedure code B4105)...

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