Monthly Archives - January 2024

Provider Alert!
19Jan

Provider Alert! Updated: Medicaid Preferred Drug List and Formulary Changes

Date: January 18, 2024 Attention: All Providers Effective Date: January 26, 2024 This is an update for a communication that was previously posted on 12/18/2023. Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective January  26, 2024, select medication(s) moved from “preferred” or “non-reviewed” 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)...

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Provider Alert!
16Jan

Provider Alert! Individual Service Plans (ISPs) are now available from the Provider Portal!

Date: January 8, 2024 Attention: Financial Management Service Agencies (FMSA) Providers Call to action: Texas Children’s Health Plan (TCHP) is pleased to announce that our STAR Kids member’s Individual Service Plans (ISPs) are now available from the provider portal. Revisions to ISPs related to the provider rate changes were completed on December 30, 2023 and FMSAs can use this link below to access them. Steps for accessing the ISPs are as follows: Tapestry Link user logs into Texas Children’s® Link.  Accessible here https://epiccarelink.texaschildrens.org/EpicCareLink/common/epic_login.aspFor more...

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Provider Alert!
12Jan

Provider Alert! Update to Therapeutic Optometry Billing Services for CPT Code 65778

Date: January 12, 2023 Attention: Therapeutic Optometrists Effective: April 11, 2024 Call to action: Effective for dates of service on or after April 11, 2024, therapeutic optometrists are to bill with taxonomy code 152WV0400X (optometry vision therapy) when billing for placement of amniotic membrane on the ocular surface; without sutures, CPT code 65778. Next steps for providers: Providers should verify they are enrolled through Texas Medicaid & Healthcare Partnership (TMHP) under the therapeutic optometry taxonomy with code 152WV0400X in order for claims to process...

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Provider Alert!
09Jan

Provider Alert! Psychosocial Care Interventions as First-Line Treatment for Children and Adolescents

Date: January 8, 2023 Attention: Behavioral Health Providers Call to ActionTexas Children Health Plan (TCHP) encourages providers to continue to take measures to ensure your patients, our members, receive excellent care. TCHP is committed to optimizing the quality of care provided to our members with behavioral health condition(s). TCHP would like to share information on first-line psychosocial care recommendations for children and adolescents before and along with prescribing antipsychotics. Why it MattersAntipsychotic medications are frequently prescribed for nonpsychotic conditions, for which psychosocial care...

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08Jan

Provider Alert! Addition of Paxlovid (Pfizer Oral Covid-19 Drug) to Formulary

Date: January 8, 2024 Attention: Providers Effective date: January 4, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective January 4, 2024, the Texas Health and Human Services (HHS) added Paxlovid to the formulary. Paxlovid (nirmatrelvir co-packaged with ritonavir) is an oral antiviral tablet, is indicated for the treatment of mild-to-moderate COVID-19 in adults who are at high risk for progression to severe COVID-19, including hospitalization or death. How this impacts providers: Please see below for the list...

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Provider Alert!
05Jan

Provider Alert! Nutramigen LGG Powdered Infant Formula Recall

Date: January 5, 2024 Attention: All Providers Effective: December 30, 2023 Call to action: Texas Children’s Health Plan (TCHP) received notice of an urgent recall from The Food and Drug Administration (FDA) for certain Nutramigen Hypoallergenic Infant Formula Powder products due to possible Cronobacter sakazakii contamination. The FDA is alerting parents, caregivers and health care providers not to use the recalled products. These recalled powdered infant formulas may be contaminated with Cronobacter sakazakii, a bacterium that can cause severe illness caused by food contamination. No illnesses have...

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Provider Alert!
03Jan

Provider Alert! Rate Changes for Ambulatory Surgical Centers

Date: January 3, 2024 Attention: Ambulatory Surgical Centers (ASCs) Effective: June 1, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to notify providers that Texas Health and Human Services Commission (HHSC) revised fee-for-service reimbursement rates for Ambulatory Surgical Centers (ASCs) and Hospital ASCs effective June 1, 2023. These rate revisions shift from the group rate and locality code method of payment for each procedure code and instead assigns fees by procedure code. How this impacts providers: TCHP is reprocessing affected claims submitted with...

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Provider Alert!
03Jan

Provider Alert! New video, Mood Disorders in Primary Care

Date: January 2, 2024 Attention: All Providers Call to action: Texas Children Health Plan (TCHP) Care Coordination Team is pleased to provide a video on mood disorders available here, Mood Disorders in Primary Care.  The video is on Bipolar Disorder and Major Depressive Disorder in children and adolescents.  In the video, you will find not only a brief overview of the mood disorders, but also tips for engaging your patients and recommendations for when to refer your patient to a mental health...

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Provider Alert!
03Jan

Provider Alert! Enter Missing EVV Visits and New EVV TAC Rules

Date: January 3, 2024 Attention: STAR Kids Providers/Consumer Directed Services employers and FMSA Providers Effective: June 1, 2023 Call to action: Update 2/6/2024: Texas Children’s Health Plan (TCHP) would like to let providers know that the Texas Health and Human Services Commission (HHSC) implemented a claim matching bypass on February 1, 2024 — for EVV claims with dates of service from January 1 through March 31 — to be paid without a matching EVV visit. Billing Claims If billing through the HHAeXchange system, you must ensure...

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Provider Alert!
03Jan

Provider Alert! Pegfilgrastim-pbbk (Fylnetra), Procedure Code Q5130, a Benefit of Texas Medicaid

Date: January 3, 2024 Attention: Providers Effective date: November 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 November 1, 2023, colony stimulating factors pegfilgrastim-pbbk (Fylnetra), procedure code Q5130, is a benefit of Texas Medicaid. How this impacts providers: For a list of payable diagnosis codes, providers may refer to the Texas Medicaid Provider Procedures Manual (TMPPM), Outpatient Drug Services Handbook, subsection 6.28, “Colony Stimulating Factors (Filgrastim, Pegfilgrastim, and Sargramostim).”...

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