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Provider Alert!
27Sep

Provider Alert! EVV Home Health Care Services (HHCS) Service Bill Codes Table Now Available

Date: September 26, 2023 Attention: STAR Kids Providers/Consumer Directed Services employers, and FMSA Providers Call to action: Texas Children’s Health Plan (TCHP) would like to inform applicable providers that a new version of the electronic visit verification (EVV) Health and Human Services (HHCS) Bill Codes Table has posted. The table is on the EVV 21st Century Cures Act webpage in Excel and PDF formats. Background:Electronic Visit Verification (EVV) will be implemented for Medicaid home health care services (HHCS) on January 1, 2024. Program providers and financial management services agencies...

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Provider Alert!
27Sep

Provider Alert! 2023-24 RSV Season and Synagis Prior Authorization Begins Oct. 2 For Lower South Texas

Date: September 26, 2023 Attention: All Providers Effective date: October 2, 2023 Call to action: Health and Human Services Commission (HHSC) will begin the 2023-24 Medicaid and CHIP-covered monthly prophylaxis for RSV on October. 2, 2023, for all counties in State Health Service Region 11. We will not open any other regions for Medicaid coverage of RSV prophylaxis at this time. Refer to the season schedule for each region's start and end dates. HHSC will continue working with the Texas Pediatric Society's task force to determine...

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Provider Alert!
27Sep

Provider Alert! Clinical Criteria for Leqembi® (procedure code J0174) effective November 1, 2023

Date: September 26, 2023 Attention: Physicians Effective date: November 1, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective November 1 2023, the Texas Health and Human Services (HHSC) will be implementing prior authorization criteria for Leqembi® (procedure code J0174) for fee-for-service Medicaid. Leqembi (Lecanemab-irmb) is an amyloid-beta directed antibody indicated for early stages of Alzheimer’s disease. Prior Authorization Requirements: Criteria for Initial Approval: Patient has Alzheimer’s disease (Diagnosis codes: G30.0, G30.1, G30.8 or G30.9) AND Prescriber attestation that...

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Provider Alert!
27Sep

Provider Alert! Clinical Criteria for Hemgenix® (procedure code J0174) effective November 1, 2023

Date: September 26, 2023 Attention: Physicians Effective date: November 1, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective November 1 2023, the Texas Health and Human Services (HHSC) will be implementing prior authorization criteria for Hemgenix® (procedure code J1411) for fee-for-service Medicaid. Hemgenix (etranacogene dezaparvovec-drlb) is an adeno-associated virus vector-based gene therapy indicated to treat adult patients with Hemophilia B (congenital Factor IX deficiency). Prior Authorization Requirements: Coverage will be provided for one dose and may...

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Provider Alert!
26Sep

Provider Alert! EVV Users Must Complete Visit Maintenance Before They Lose Access on December 22, 2023

Date: September 25, 2023 Attention: STAR Kids Providers/Consumer Directed Services employers, and FMSA Providers Background information: As a reminder, HHAeXchange will go-live for current EVV users that have not on boarded as a proprietary system operator on October. 1, 2023. Call to action: The purpose of this communication is to inform program providers, financial management services agencies (FMSAs) and Consumer Directed Services (CDS) employers transitioning to the new state EVV vendor, HHAeXchange, are responsible for completing all required visit maintenance (including visit maintenance...

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Provider Alert!
26Sep

Provider Alert! Electronic Visit Verification Data Access and Conversion

Date: September 25, 2023 Attention: STAR Kids Providers/Consumer Directed Services employers, and FMSA Providers Call to action: This notice is for program providers, financial management services agencies (FMSAs) and Consumer Directed Services (CDS) employers transitioning to the new state-funded EVV vendor, HHAeXchange. All visits in the EVV Aggregator will continue to be available and accessible for program providers, FMSAs, and CDS employers. One year of historical accepted visits will be available in HHAeXchange as part of data conversion. This will be based on...

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25Sep

Provider Alert! HHSC Does Not Cover Vaccines or Drugs That Do Not Have FDA Approval or Emergency Use Authorization

Date: September 25, 2023 Attention: All Providers Effective date: August 31, 2023 Call to action: The purpose of this communication is to inform providers that Texas Medicaid and CHIP do not cover vaccines or drugs that are not authorized or approved by the U.S. Food and Drug Administration (FDA). Health and Human Services Commission (HHSC) will not cover procedure codes related to COVID-19 vaccine or drugs administration as non-risk payments (NRP) if the COVID-19 vaccines or drugs no longer have FDA approval or authorization....

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Provider Alert!
22Sep

Provider Alert! Discontinuation of EVV Required Free Text Reviews

Date: September 22, 2023 Attention: STAR Kids Providers/Consumer Directed Services employers, and FMSA Providers Effective date: Immediately for dates of service beginning August 1, 2023 Background information: As you may know, as part of Electronic Visit Verification (EVV) compliance reviews, payers like Texas Children’s health Plan, review EVV visit transactions to determine if required free text is entered when using a reason code. Health and Human Services Commission (HHSC) is discontinuing required free text reviews of EVV visit transactions beginning with dates of services...

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Provider Alert!
22Sep

Provider Alert! Registration Available for HHSC EVV Policy Training Webinars for Program Providers, FMSAs and CDS Employers

Date: September 21, 2023 Attention: STAR Kids Providers/Consumer Directed Services employers, and FMSA Providers Webinar dates: October 5 or 19 and November 2 Call to action: Texas Children’s Health Plan (TCHP) encourages provider’s attendance at the upcoming webinars hosted by Health and Human Services Commission (HHSC). This training will cover Electronic Visit Verification (EVV) policy training. The intended audience is program providers; financial management services agencies (FMSAs) and Consumer Directed Services (CDS) employers in order to complete the EVV Policy Handbook training requirement. Webinar...

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Provider Alert!
21Sep

Provider Alert! Correction to EVV Policy Updates Now Available for Alternative Devices

Date: September 21, 2023 Attention: STAR Kids Providers/Consumer Directed Services employers, and FMSA Providers Effective date: October 1, 2023 Call to action: The purpose of this communication is to correct what was previously published. Health and Human Services Commission (HHSC) sent a GovDelivery notice on September 13, 2023 for the new and revised Electronic Visit Verification (EVV) alternative device policy. Texas Children’s Health Plan (TCHP) published a provider alert upon receipt. Correction explanation: The correction is to state that qualified members using the Agency Option...

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