Monthly Archives - October 2023

Provider Alert!
27Oct

Provider Alert! Encourage Members to Protect Themselves Against the Flu

Date: October 27, 2023 Attention: All Providers Attention Primary Care Providers: With ongoing cases of highly contagious respiratory illnesses, it is important to remind patients to protect themselves and their families by getting routine vaccinations. This can help prevent unnecessary medical visits and hospitalizations that continue to put a strain in our healthcare systems. Getting vaccinated for the flu and COVID-19 can prevent the spread of the disease. Every person 6 months and older should be vaccinated with any licensed, age-appropriate flu vaccine with no preference...

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Provider Alert!
26Oct

Provider Alert! Update: Delivery of Certain Behavioral Health Services through Synchronous Audiovisual or Synchronous Telephone (Audio-Only) Technology

Date: October 25, 2023 Attention: Behavioral Health Providers Effective date: December 1, 2023 Call to action: The purpose of this communication is to offer information about updates to most of the behavioral health Medicaid benefits to clarify the delivery of those services through synchronous audiovisual or synchronous telephone (audio-only) technology. How this impacts providers: The Texas Medicaid & Healthcare Partnership (TMHP) will update the Texas Medicaid Provider Procedures Manual (TMPPM), Behavioral Health and Case Management Services, effective December 1, 2023. Handbook (Vol. 2, Provider...

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Provider Alert!
25Oct

Provider Alert! HHAeXchange EVV Training Resources Available

Date: October 24, 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 they can attend HHAeXchange Open Hours webinar sessions to ask questions, see methods demonstrated or schedule a one-on-one session for additional help and training. Open Hours Webinar Sessions Webinar sessions will be available Monday through Friday until November 3, 2023, and do not require registration. Attendees can drop in and out between the selected hours...

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Provider Alert!
23Oct

Provider Alert! 2023-24 RSV Season Updates

Date: October 23, 2023 Attention: All Providers Please note: This Provider Alert will be continuously updated as new regions are opened or closed. Please check back on this alert for updates. Attention Primary Care Providers: Respiratory syncytial virus (RSV) seasons is here. RSV is a common respiratory virus that usually causes mild, cold-like symptoms. Most people recover in a week or two, but RSV can be serious. Infants and older adults are more likely to develop severe RSV and need hospitalization. It is important to...

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Provider Alert!
19Oct

Provider Alert! Provider Reminder, Labor and Delivery Inpatient Information

Date: October 19, 2023 Attention: Obstetric Care Providers and Hospitals Effective date: Informational notice only Call to action: Texas Children’s Health Plan (TCHP) allows for up to three days prior to a delivery in addition to the federally mandated days after delivery.  Admissions resulting in delivery during this time frame do not require a prior authorization. Likewise, inpatient admissions for CHIP Perinate do not require authorization. How this impacts providers: Inpatient admissions related to spontaneous labor or induction of labor that result in delivery...

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19Oct

Provider Alert! Clinical Criteria for Qalsody® (procedure code C9157) effective October 1, 2023

Date: October 19, 2023 Attention: All Providers Effective Date: October 1, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective October 1, 2023, Texas Health and Human Services Commission (HHSC) will be implementing prior authorization criteria for Qalsody® (procedure code C9157).Qalsody® (Tofersen) is an antisense oligonucleotide indicated for the treatment of amyotrophic lateral sclerosis (ALS) in adults who have a mutation in the superoxide dismutase 1 (SOD1) gene Prior Authorization Requirements: Criteria for Initial Approval: Patient is 18...

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Provider Alert!
18Oct

Provider Alert! New Information – HHSC Adopts Proposed Payment Rates for Attendant Services in Various Programs

Date: October 18, 2023 Attention: Providers and Financial Management Services Agencies (FMSAs) Effective Date: September 1, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective for dates of service on or after September 1, 2023, Texas Health and Human Services Commission (HHSC) shared payment rate changes for attendant services. In response to the 2024-25 General Appropriations Act, House Bill 1, 88th Legislature, Regular Session, 2023 (Article II, HHSC, Rider 30(a)), HHSC has increased the base wage for...

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Provider Alert!
17Oct

Provider Alert! EVV Optional Services Now Available in PCS Bill Codes Table

Date: October 17, 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 the Texas Health and Human Service Commission (HHSC) has published a new version of the Electronic Visit Verification (EVV) Personal Care Services (PCS) Bill Codes Table. Version 12 is now available on the HHSC EVV webpage in Excel and PDF formats. The new version includes Supported Employment and Transportation as EVV optional services. Program providers and Financial Management Services Agencies (FMSAs) can...

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Provider Alert!
11Oct

Provider Alert! New Texas Medicaid & Healthcare Partnership (TMHP) Contracts

Date: October 10, 2023 Attention: All Providers Effective date: September 1, 2023 Call to action: The purpose of this communication is to inform providers that effective September 1, 2023 two new Texas Medicaid and Healthcare Partnership (TMHP) contracts went live: Accenture State Healthcare Services LLC (Accenture) is now the TMHP Business Operations and Business Integration (BusOps) vendor. The TMHP BusOps vendor acts as the project management office across the TMHP vendors and will manage the overall Medicaid ecosystem, including support services such as project management,...

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Provider Alert!
11Oct

Provider Alert! You’re Invited to Our Provider Advisory Group!

Date: October 10, 2023 Attention: All Providers Event dates for the upcoming sessions are based on Service Delivery Area: Tuesday, December 5, 2023 Northeast SDAThursday, December 7, 2023 Jefferson SDATuesday, December 12, 2023 Harris SDAAll sessions will be from 12:00PM (Noon) – 1:30PM CST Call to action: Texas Children’s Health Plan (TCHP) invites you to join our quarterly Provider Advisory Group (PAG). We will hold our next round of sessions in December and dates are based on Service Delivery Area (SDA) as described above. Click...

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