Monthly Archives - April 2023

Provider Alert!
12Apr

Provider Alert! Livmarli Clinical Prior Authorization Criteria Revision Scheduled for May 30, 2023

Date: April 11, 2023 Attention: All Providers Effective Date: May 30, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective May 30, 2023, the Health and Human Services Commission (HHSC) will update prior authorization criteria for Livmarli that meets the recent FDA-approved age indication. How this impacts providers: Starting May 30, 2023, TCHP will expand the age requirement to pediatric patients three months and older. Next steps for providers: Prescribers should share this communication with their staff. Provider...

By Facilities, HHSC, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialists, , , 0 CommentsRead more...
Provider Alert!
12Apr

Provider Alert! Appealing Legacy Claims within our Provider Portal, Texas Children’s Link

Date: April 10, 2023 Attention: All Providers Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers utilizing Texas Children’s Link, our online provider portal, how to access and appeal legacy claims within this platform. Legacy Claims are defined as claims with a submission date prior to August 1, 2022.   Click here for the steps to access and appeal legacy claims. We hope this option improves your daily operations and makes the claims reconciliation process much easier. Background information: Texas...

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Provider Alert!
11Apr

Provider Alert! FDA Withdrawal of Makena®

Date: April 10, 2023 Attention: All Providers Effective Date: April 06, 2023 Call to action: Effective April 6, 2023, the U.S. Food and Drug Administration (FDA) announced the final decision to withdraw the approval of Makena and its generics, which was approved to reduce the risk of preterm birth in women pregnant with one baby who have a history of spontaneous preterm birth. Makena and its generics are no longer FDA approved and cannot be lawfully distributed. This is in result due to...

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Provider Alert!
10Apr

Provider Alert! Clinical Criteria for Xenpozyme Procedure Code J0218 effective May 1, 2023

Date: April 6, 2023 Attention: All Providers Effective Date: May 1, 2023 Call to action: Effective May 1, 2023, the Health and Human Services Commission (HHSC) will begin the incorporation of prior authorization criteria for Xenpozyme (procedure code J0218) to the Enzyme Replacement Therapy policy. Xenpozyme is the first therapy indicated specifically for the treatment of non-central nervous system manifestations of acid sphingomyelinase deficiency (ASMD) in adult and pediatric patients, and is currently the only approved treatment for this disease. Authorization Requirements 1. Member has...

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