Author - Texas Children's Health Plan

Provider Alert!
27Mar

Provider Alert! EVV Program Providers and FMSAs: Register for HHAeXchange Town Hall Webinar Thursday, March 28

Date: March 27, 2024 Attention: STAR Kids Providers/Consumer Directed Services employers and FMSA Providers Call to action: Texas Children’s Health Plan (TCHP) would like to let program providers and financial management services agencies (FMSAs) know about the upcoming Electronic Visit Verification (EVV) Town Hall Webinar on Thursday, March 28, from 1–3 p.m. (Central time). Agenda Overview of the EVV Transition EVV System Enhancements Addressing Key Concerns and Frequently Asked Questions Support Resources Q&A Session Register Now. Next steps for providers: Providers are encouraged to share this communication with their staff. If you...

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Provider Alert!
26Mar

Provider Alert! New EVV Visit Transaction Rejection Codes to Begin April 1, 2024

Date: March 26, 2024 Attention: STAR Kids Providers/Consumer Directed Services employers and FMSA Providers Effective Date: April 1, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that beginning April 1, Electronic Visit Verification (EVV) visit transactions with dates of service on or after April 1, 2024, will receive new visit transaction rejection codes if the EVV Aggregator receives incomplete or incorrect data. Program providers and financial management services agencies (FMSAs) will see these new rejection codes in...

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Provider Alert!
26Mar

Provider Alert! Billing EVV Services as Secondary Insurance Claims

Date: March 26, 2024 Attention: STAR Kids Providers/Consumer Directed Services employers and FMSA Providers Call to action: Texas Children’s Health Plan (TCHP) would like to share updates to the process of billing secondary insurance for program providers and financial management services agencies (FMSAs). With the implementation of EVV for the Home Health Care Services on January 1, 2024, concerns were brought forward regarding the billing EVV services as secondary insurance claims. Specifically, it was shared that a reason for denial is needed from...

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Provider Alert!
26Mar

Provider Alert! Availity Now Offered to Providers for Electronic Claims Submission

Date: March 26, 2024 Attention: All Providers Effective Date: March 25, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to announce that Availity is now available as a clearinghouse option for electronic claims submissions. Getting Started with Availity: If a provider already uses Availity as a clearinghouse, then claims will route to TCHP payer IDs as normal (payer ID information can be found in the TCHP Institutional Guide and TCHP Professional Guide). No additional action is required. If a provider uses Change Healthcare...

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Provider Alert!
22Mar

Provider Alert! UPDATED: Notification of CORF/ORF Reimbursement Policy

Date: March 22, 2024 Attention: Comprehensive Outpatient Rehabilitation Facility (CORF) and Outpatient Rehabilitation Facility (ORF) Providers Effective Date: June 1, 2024 Call to action: The purpose of this communication is to make providers aware of a new reimbursement policy for Texas Children’s Health Plan (TCHP), which outlines the billing requirements for Comprehensive Outpatient Rehabilitation Facility (CORF) and Outpatient Rehabilitation Facility (ORF) provider types. This policy applies to CHIP and Medicaid lines of business. This policy does not apply to ECI, Home Health, Individual...

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Provider Alert!
22Mar

Provider Alert! Change in PDL Status for Antivirals, Oral Drug Class

Date: March 22, 2024 Attention: All Providers Effective date: March 7, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective March 7, 2024, valganciclovir tablet will now be preferred along with brand Valcyte. This is in response to the shortage of the brand product Valcyte by the manufacturer. How this impacts providers: The change will allow providers to prescribe the generic without requiring preferred drug list (PDL) prior authorization at this time and continue accessing necessary...

By Facilities, HHSC, OB/GYNs, Office Managers, Pharmacy, Primary Care Providers, Provider Alert, Specialists, 0 CommentsRead more...
Provider Alert!
22Mar

Provider Alert! Sleep Studies no longer require Prior Authorization

Date: March 22, 2024 Attention: All Providers Effective date: February 7, 2024 Call to action: Effective for dates of service on or after February 7, 2024, Texas Children’s Health Plan (TCHP) will not require a prior authorization for sleep studies. Disclaimer: It is the responsibility of the Provider to verify that a service is a benefit of Texas Medicaid for service codes that TCHP does not require prior authorization. Services rendered by out-of-network providers will require prior authorization. TCHP would like to remind providers that...

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Provider Alert!
19Mar

Provider Alert! Annual HEDIS ® Medical Record Review Process has started

Date: March 19, 2024 Attention: Primary Care Providers Review Period: Now through April Call to action: TCHP would like to inform network providers that the HEDIS® medical record data review process began in February 2024 and will proceed through April 29, 2024. Additionally, we have contracted with Inovalon, Inc. to retrieve medical records and perform HEDIS® medical record data abstraction on our behalf. All medical records must be in to Inovalon by Monday, April 29, 2024. Please note the following: Inovalon serves as TCHP’s...

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Provider Alert!
18Mar

Provider Alert! Omnipod 5 Added to Medicaid and CHIP Formularies

Date: March 18, 2024 Attention: All Providers Effective date: February 22, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective February 22, 2024, the Texas Health and Human Services (HHSC) allows coverage for Omnipod 5 through pharmacy benefit for both CHIP and Medicaid formularies. Members can obtain one (1) Omnipod 5 G6 intro kit per 365 days, and fifteen (15) units of Omnipod 5 C6 PODS per 30 days. HHSC is not requiring clinical prior...

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Provider Alert!
07Mar

Provider Alert! EVV Claims Matching Resumes April 1, 2024; Unmatched EVV Claims will Deny for Payment

Date: March 7, 2024 Attention: STAR Kids Providers/Consumer Directed Services employers and FMSA Providers Effective Date: April 1, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that Texas Health and Human Services Commission (HHSC) implemented a claim matching bypass on February 1, 2024 – for Electronic Visit Verification (EVV) claims with dates of service from January 1 through March 31 – to be paid without a matching EVV visit. EVV claims matching for all services required to use...

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