Provider Alert! Updated Rendering Provider Edit RequirementsTexas Children's Health Plan
Date: August 12, 2022
Attention: All Providers
Effective Dates: June 21, 2022 for rendering edit requirements overall
September 6, 2022 for new exemptions
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 remind providers of new billing requirements for the rendering provider that went into effect on June 21, 2022. This update in accordance with the guidance from the Texas Medicaid Provider Procedures Manual (TMPPM) section 6.1.2, Claims Filing Instructions. In order for claims to process accordingly providers may need to update their billing practices. Our contracted clearinghouse, Change Healthcare (CHC), will reject any claims that do not contain proper Billing Provider Taxonomy Numbers and/or Billing Providers NPI’s, or rendering provider taxonomy.
Resource: TMPPM Section 6.1.2, Claims Filing Instructions
How this impacts providers: Here is a summary of the required fields for Professional 837P (CMS/1500) Claims:
|2000A PRV (billing taxonomy required)*
2300 CLM05-01 (header, place of service code)
2400 SV105 (service detail, place of service code)
|§ This applies to all organizational types Group and person.
§ If group, then rendering provider name, NPI, and Taxonomy are required and a valid NPI and valid Taxonomy.
§ Taxonomy and NPI used should be those attested with at Texas Medicaid
§ There are no attestation checks at CHC; this is done at TCHP for billing provider and rendering provider.
§ CHC will check the following:
§ Each detail service line. If “ALL” lines do not meet exemption Place of Service (POS) list, the edit for rendering provider/taxonomy will appear and
§ CHC will also check the header and service detail line POS values.
§ TCHP’s contracted clearinghouse, CHC, will reject any claims that do not contain proper Rendering Provider Taxonomy Numbers and/or Rendering Providers NPI’s
|2310B PRV (Rendering Provider Taxonomy required if not excluded)||§ Taxonomy and NPI used should be those attested with at Texas Medicaid
*2000A PRV (Billing Taxonomy to Bypass)
NEW exemption information effective September 6, 2022: Some CPT/HCPCS Codes with G/H/T as follows:
- Radiology CPT Codes 7xxxx
- Anesthesiology CPT Codes 00100-01999
- Pathology/Labs CPT Codes 8xxxx
- Proprietary Laboratory Analyses CPT Codes 0001U-0241U
- Home Health – T1019-T1022
- Durable Medical Equipment – E0100-E8002, K0001-K0900, L0112-L4631, L5000-L9900
- Transportation – A0021-A0999 and T2001-T2007
- Dialysis Services – 90935-90999
- Long Term Services Supports — S5101, T1019, S5161, S5160, G0162, T1000, T1025, T1026, T2002, T2040, T1005, T2027, H2015, T2028, T2029, T2039, S5165, T2038, H2025, H2023
The following Place of Service codes do not require a rendering provider:
10 Telehealth Provided in Patient’s Home
25 Birthing Center
31 Skilled Nursing Facility
32 Nursing Facility
33 Custodial Care Facility
42 Ambulance- Air or Water
50 Federally-Qualified Health Center
62 Comprehensive Inpatient Rehabilitation Center
65 End-Stage Renal Disease Treatment Facility
72 Rural Health Clinic
81 Independent Laboratory
Next steps for providers: Providers should share this communication with their billing staff and work with their clearinghouse to ensure updates are made prior to the effective date.
If you have any questions, please contact your Provider Relations Liaison or email the Provider Relations Department at: firstname.lastname@example.org.