Monthly Archives - July 2023

Provider Alert!
28Jul

Provider Alert! Update to the Long-Term Services and Supports Billing Matrix and Crosswalk

Date: July 28, 2023 Attention: STAR kids Providers Billing matrix has been updated effective: July 7, 2023 Call to action: The purpose of this communication is to inform providers of updates made to the LTSS billing matrix effective July 7, 2023. Description of the updates:   Health and Human Services Commission (HHSC) added language to clarify that the U6 modifier must be added to all prior authorizations and encounter claims for state plan LTSS for members in the Medically Dependent Children Program (MDCP) HHSC also made corrections to...

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Provider Alert!
25Jul

Provider Alert! Extensive Case Management Programs Available for Members

Date: July 25, 2023 Attention: All Providers Call to action: Texas Children’s Health Plan (TCHP) would like to remind providers that extensive case management and service coordination programs are available to our members. In addition, several virtual classes are offered to our members in English and Spanish. Our case managers play an important role in assisting our members with obtaining the necessary medical and/or behavioral health care, support, resources and services they need to achieve the best possible health outcomes.  How this impacts providers:...

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Provider Alert!
25Jul

Provider Alert! Reminder: Patient Access to Mosquito Repellents Available Through Pharmacy

Date: July 25, 2023 Attention: All Providers Call to action: Texas Health and Human Services Commission (HHSC) would like to remind pharmacies and other providers of the mosquito repellent pharmacy benefit. According to a June 26 Centers for Disease Control and Prevention notice, locally acquired malaria cases were identified in Texas. To prevent and control the spread of malaria and other mosquito-borne diseases in Texas, HHSC reminds pharmacies and other providers of the mosquito repellent pharmacy benefit. How this impacts providers: HHSC covers mosquito repellents year-round to...

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Provider Alert!
25Jul

Provider Alert! TexMedConnect and EVV Portal Access

Date: July 25, 2023 Attention: Home Health Care Services Providers, STAR Kids Providers/Consumer Directed Services employers and FMSA Providers Effective Date: January 1, 2024 Call to action: The Texas Health and Human Services Commission (HHSC) would like to let providers know that Electronic Visit Verification (EVV) will be required for Home Health Care Services (HHCS) as of January 1, 2024. The HHCS required to use EVV are found in the document, Programs, Services and Service Delivery Options Required to Use Electronic Visit Verification by January...

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Provider Alert!
21Jul

Provider Alert! Medicaid Preferred Drug List and Formulary Changes

Date: July 21, 2023 Attention: All Providers Effective Date: July 27, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective July 27, 2023, select medication(s) moved from “preferred” to “non-preferred” status. A summary of the changes is included below. Resource: https://www.txvendordrug.com/formulary/preferred-drugs Changes with biggest impact to Texas Children Health Plan members and providers: The drugs listed below were either not previously reviewed (NR) and became non-preferred (NPD) or previously considered a preferred agent (PDL) but now have changed...

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Provider Alert!
21Jul

Provider Alert! EVV Proprietary System Operator Waitlist is Full

Date: July 20, 2023 Attention: STAR Kids Providers/Consumer Directed Services employers and FMSA Providers Call to action: The Texas Health and Human Services Commission (HHSC) is notifying all program providers and FMSAs that the waitlist to onboard as an EVV Proprietary System Operator (PSO) is full. Program providers or FMSAs on the waitlist as of Friday, June 23, 2023, will participate in the expedited PSO onboarding session planned between July 15 through Aug. 31. How this impacts providers: Program providers and FMSAs who...

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Provider Alert!
19Jul

Provider Alert! 2024 Annual Hospitals Standard Dollar Amount Verification

Date: July 19, 2023 Attention: Non-Rural and Non-State-Owned Hospital Providers Due date for the SDA Add-on Status Verification Form, if required: July 24, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers about the 2024 Annual Hospitals Standard Dollar Amount Verification. Background information: In accordance with Texas Administrative Code (TAC), §355.8052(d)(9), related to Medicaid Inpatient Hospital Reimbursement, hospitals may receive an annual standard dollar amount (SDA) adjustment based upon their trauma and/or safety-net designation. If qualified, hospitals may also...

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Provider Alert!
19Jul

Provider Alert! Prior Authorization Updates for Neurostimulators and Neuromuscular Stimulators

Date: July 18, 2023 Attention: All Providers Effective date: July 1, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers of a new prior authorization requirement effective July 1, 2023, for neurostimulators and transcutaneous electrical supply- CPT Code A4560. How this impacts providers: This prior authorization requirement aligns with the TMPPM and applies to all lines of business CHIP, STAR, and STAR Kids. There is a limit to one unit every 12 weeks or four units per year. Source: Texas...

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Provider Alert!
19Jul

Provider Alert! Zynteglo® now a Medicaid and CHIP Benefit – Prior Authorization Effective September 1, 2023

Date: July 18, 2023 Attention: All Providers Effective Date: September 1, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective September 1, 2023, the Texas Health and Human Services (HHSC) will be implementing required prior authorization criteria for Zynteglo® (procedure code J3590) for Medicaid and CHIP. Zynteglo® became a benefit of Medicaid and CHIP on July 1, 2023. Zynteglo® (betibeglogene autotemcel) is an autologous stem cell-based gene-therapy indicated for treating adult and pediatric patients with...

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Provider Alert!
17Jul

Provider Alert! Prenatal Dental Care Information

Date: July 13, 2023 Attention: Ob-Gyn Providers Call to action: Texas Children’s Health Plan (TCHP) would like to remind OB-Gyn providers about the availability of dental benefits for pregnant Medicaid members. The CDC and ACOG both recommend routine dental care during pregnancy, but TCHP has noted a limited number of pregnant women are familiar with dental benefits. Routine dental care during pregnancy is safe and can improve maternal oral health, decreasing future dental issues for the mother and improving oral health for...

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