Author - Texas Children's Health Plan

Provider Alert!

Provider Alert! Texas Children’s® Link, Online Provider Portal Claim Submission Guidance

Date: March 1, 2024 Attention: All Providers Call to action: In response to Optum’s recent Change Healthcare network interruption, Texas Children’s Health Plan (TCHP) would like to provide details on the claim submission methods currently available. Where can providers submit claims: The most efficient option is submitting claims and appeals through Texas Children's® Link, our provider portal https://epiccarelink.texaschildrens.org/ The batch claim submission process is available on the portal, where 837 files can be uploaded directly onto Texas Children's® Link. To access this from Texas Children's® Link,...

Provider Alert!

Provider Alert! Notification of Observation/Treatment Room and E&M Services Reimbursement PolicyProvider Alert!

Date: February 29, 2024 Attention: Hospital facilities Effective Date: May 27, 2024 Call to action: The purpose of this communication is to make hospital facilities aware of a new reimbursement policy for Texas Children’s Health Plan (TCHP), which outlines the billing restrictions for observation and treatment room revenue codes billed with evaluation and management (E&M) services.  This policy applies to hospitals billing outpatient services, and applies to CHIP and Medicaid lines of business. How this impacts providers: Policy guidelines are as follows:Observation and treatment...

Provider Alert!

Provider Alert! Infant Well-Child Visit Reminder

Date: February 28, 2024 Attention: Primary Care Providers Call to action: Texas Children’s Health Plan (TCHP) encourages providers to ensure their infant patients are receiving timely well-child visits and immunizations, in compliance with the Texas Health Steps (THSteps) periodicity schedule. More specifically, visits must be scheduled on or before the patient’s birth month in order for them to be considered compliant with Health and Human Services (HHSC) THSteps requirements.  TCHP is committed to ensuring members recognize the importance of preventive care and...

Provider Alert!

Provider Alert! Coverage of Elevidys Begins January 2024

Date: February 27, 2024 Attention: All Providers Prior authorization effective date: February 1, 2024 Call to action: The purpose of this communication is to inform providers that on January 1, 2024, Elevidys became a benefit of Medicaid and CHIP. Texas Health and Human Services Commission (HHSC) requires prior authorization for Elevidys (procedure code J1413) for Medicaid and CHIP, effective February 1, 2024. Elevidys is an adeno-associated virus vector-based gene therapy indicated for the treatment of ambulatory pediatric clients ages 4 through 5 years with...

Provider Alert!

Provider Alert! Updates to Vaccine Administration Procedure Code M0201

Date: February 26, 2024 Attention: All Providers Effective: January 1, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective January 1, 2024, vaccine administration add-on procedure code M0201 may be billed in the home setting with the following procedure codes: 906309063690654906559065690657906589066090661906629067090671906729067390674906779068290685906869068790688906949069790723907329073990740907439074490746907479075690759   M0201 will be payable as an add-on code if billed with any of these vaccines, along with the existing COVID-19 vaccine administration procedure code, if administered inside a client’s home. TCHP will reprocess affected claims submitted with the...

Provider Alert!

Provider Alert! HCPCS and CPT Code Prior authorization Update

Date: February 26, 2024 Attention: All Providers Effective date: January 1, 2024 Call to action: The purpose of this communication is to offer information about the Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) prior authorization updates. Resource: https://www.tmhp.com/sites/default/files/file-library/resources/rate-and-code-updates/hcpcs-updates/2024-hcpcs-special-bulletin.pdf How this impacts providers: Effective January 1, 2024 Texas Children’s Health Plan’s (TCHP's) prior authorization updates are listed below. These changes follow guidance from Texas Medicaid and Healthcare Partnership (TMHP). Medical necessity criteria for utilization review will be in accordance with Texas Medicaid...

Provider Alert!

Provider Alert! Enzyme Replacement Therapy Prior Authorization Update

Date: February 26, 2024 Attention: All Providers Effective date: February 1, 2024 Call to action: Texas Children’s Health Plan would like to make providers aware of prior authorization updates for certain enzyme replacement therapies. In alignment with Texas Medicaid Provider Procedure Manual (TMPPM) requirements, effective for dates of service on or after February 1, 2024, prior authorization will be required for enzyme replacement therapy velmanse alfa-tycv (Lamzede), procedure code J0217, and pegunigalsidase alfa-iwxj (Elfabrio), procedure code J2508. Prior Authorization Requirements include the following: Velmanse alfa-tycv...

Provider Alert!

Provider Alert! Optum’s Change Healthcare Network Interruption Update: Payment Information

Attention: All Providers Date: February 26, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to provide an update regarding Optum’s recent Change Healthcare network interruption. In an effort to mitigate the financial impact to our providers, TCHP has activated an alternative payment process that will be in effect until Optum’s Change Healthcare process is restored.   Alternative payment information  Payments for claims received will be made via check until electronic funds transfer (EFT) is setup with our Accounts Payable department (please see...

Provider Alert!

Provider Alert! UPDATED Medicaid Re-enrollment Application Assistance is Available

Date: February 22, 2024 Attention: All Providers Call to action: Texas Children's Health Plan (TCHP) would like to remind providers that continued assistance is available to their patients who need help with their Medicaid Reenrollment Application. Providers should encourage patients with Texas Children’s Health Plan coverage to contact us for assistance and support. How can you help ensure your patients stay covered?  Your continued assistance is crucial to helping your patients maintain coverage so they can access health care. Please ask your patients to:  Make...

Provider Alert!

Provider Alert! Important: Change Healthcare Network Interruption

Date: February 22, 2024Attention: All Providers Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers of some recent information we have received from our clearinghouse, Change Healthcare.   Change Healthcare is experiencing a network interruption related to a cyber-security issue and are working to address the matter. Once they became aware of the infiltration, they took immediate action to disconnect their systems to prevent further impact. At this time, they do not have an estimation of when the system...