Monthly Archives - August 2023

Provider Alert!

Provider Alert! Pharyngitis Testing Reminder

Date: August 17, 2023 Attention: Primary Care Providers Call to action: Pharyngitis (also known as sore throat) is a common, predominately viral, self-limiting condition which can be symptomatically managed without antibiotic treatment. Inappropriate antibiotic use for pharyngitis contributes to the development and spread of antibiotic resistance. Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7693205/ However, a small proportion of sore throats caused by group A streptococcal (GAS) infection may benefit from the provision of antibiotics. Establishing the cause of infection is an important step in effective antibiotic stewardship. Why it matters: Pharyngitis...

Provider Alert!

Provider Alert! Healthy Rewards/Value Added Services for 2023-2024

Date: August 16, 2023 Attention: All Providers Effective Date: September 1, 2023 Call to action: Texas Children’s Health Plan (TCHP) is proud to present our Healthy Rewards Program/Value Added Services (VAS) program effective September 1, 2023 through August 31, 2024. These rewards and services are available in each line of business CHIP, STAR, and STAR Kids and Service Delivery Areas; Harris, Jefferson and North East (limitations may apply). Member favorites, such as the Prenatal and Postpartum Visit Rewards, Portable Crib/Playpen, Diabetes Management Rewards and...

Provider Alert!

Provider Alert! Diagnosis and Age Restrictions to Change for Hydroxyprogesterone Caproate Procedure Code J1729

Date: August 9, 2023 Attention: OB Providers Effective date: August 1, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to make providers aware of changes made to Hydroxyprogesterone Caproate, Procedure Code J1729. How this impacts providers: Changes are as follows: Effective August 1, 2023, diagnosis codes O09211, O09212, O09213, and O09219 will be removed as payable diagnoses for hydroxyprogesterone caproate (procedure code J1729). Procedure code J1729 will no longer be age restricted. Procedure code J1729 will be restricted to clients who are non- pregnant...

Provider Alert! UPDATED: COVID-19 Vaccine Counseling Procedure Code G0315 Now a Benefit

Date: August 7, 2023 Attention: All Providers Effective date: Dates of service on or after December 2, 2021 Call to action: Texas Children Health Plan (TCHP) would like to inform providers that effective for dates of service on or after December 2, 2021, COVID-19 vaccine counseling procedure code G0315 is a benefit of Medicaid for individuals birth through 20 years of age. How this impacts providers: Procedure code G0315 will be limited to a maximum of three vaccine counseling services (G0315), per rolling year...

Provider Alert!

Provider Alert! Implementation of Sotyktu Criteria in Cytokine and CAM Antagonists Clinical Prior Authorization

Date: August 4, 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, the Texas Health and Human Services Commission (HHSC) implemented criteria for Sotyktu®. Sotyktu® belongs to the Cytokine and CAM Antagonists class and is indicated for the treatment of moderate-to-severe plaque psoriasis in adults who are candidates for systemic therapy or phototherapy. How this impacts providers: The new criteria is available on the HHSC...

Provider Alert!

Provider Alert! HHAeXchange Provider Onboarding Details

Date: August 3, 2023 Attention: STAR Kids Providers/Consumer Directed Services employers, and FMSA Providers Call to action: Texas Children’s Health Plan (TCHP) would like to remind providers that Texas Health and Human Services Commission (HHSC) has selected HHAeXchange as the state EVV vendor. Personal care services program providers and Financial Management Services Agencies (FMSAs) who currently use EVV vendor systems (DataLogic/Vesta or First Data/AuthentiCare) or have recently enrolled to provide personal care services and are not in the proprietary system onboarding process...

Provider Alert!

Provider Alert! EVV Updates Now Available for Policy, Reason Codes, Visit Maintenance Unlock Request and EVV Policy Training

Date: August 3, 2023 Attention: STAR Kids Providers/Consumer Directed Services employers, and FMSA Providers Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that Texas Health and Human Services Commission (HHSC) will post new and revised policies to be added to the Electronic Visit Verification Policy Handbook, effective Oct. 1. These revisions are outlined in the Policies effective Oct. 1, 2023 (PDF), located on the EVV webpage.  How this impacts providers: Revisions include: Updating Section 9000 Reason Codes to address new Reason...