News Blog

Provider Alert!
02Jan

Provider Alert! TCHP Prior Authorization Requirement

Effective January 1, 2019, TCHP will be updating the prior authorization listing. Please note there are some key changes for providers. Removed from the list and will no longer require prior authorization: Baclofen Pump New to the list: Home Telemonitoring Updates: Ambulance (non-emergent transport) has been updated to Non-Emergency Ambulance Transport. Augmentative Communication Device has been updated to Augmentative Communication Device and Accessories. Chemotherapy non-FDA approved has been updated to Non-FDA approved medications. Cranial Molding Orthosis (Helmets) has been updated to Cranial Molding Orthosis. High cost (>$50,000) injectable in the outpatient...

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Provider Alert!
01Jan

Provider Alert! Texas Standard Prior Authorization Request Form compliance grace period has ended

Starting January 1, 2019, the 90-day grace period for compliance with the exclusive use of the Texas Standard Prior Authorization Request Form has ended. From this date forward, providers must use the Texas Standard Prior Authorization Request Form, which can be found at: https://www.texaschildrenshealthplan.org/for-providers. Click on Downloadable Forms on the left-hand side, then click Standard Prior Authorization Form or Behavioral Health Authorization Form to download. As a reminder, the following essential information is required to start the authorization process: Member Name, Member Date...

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19Dec

Antivirals and the flu: know when the time is right

Antiviral medications play a role in treating influenza, but they are not a substitute for vaccination.  According to CDC recommendations, all patients at high risk for complications who appear to have influenza should be considered for early antiviral treatment, independent of laboratory confirmation or influenza vaccine status. This approach can help reduce morbidity and mortality, particularly in young children and those who have underlying co-morbidities. Clinical trials and observational data show that early antiviral treatment can shorten the duration of...

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19Dec

CDC data release shows STD diagnoses at record high in U.S.

CDC data release shows STD diagnoses at record high in U.S. The CDC has released preliminary surveillance data presented at the 2018 STD Prevention Conference in Washington, D.C. Data analysis of the five year trend of sexually transmitted diseases (STDs) showed a sharp increase in STDs for four consecutive years (see chart). In 2017, almost 2.3 million cases of chlamydia, gonorrhea and syphilis were reported to the CDC, an increase of more than 200,000 cases from 2016 (see graph). Young women continue...

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19Dec

Nutritional supplement guideline change

Effective 10/1/2018, Texas Children’s Health Plan will no longer require prior authorization for nutritional products for members 20 years and younger who: receive all or part of their nutritional intake through a tube as documented by ICD-10 codes (z43.1; z93.1, z93.4), OR have a metabolic disorder that has been documented with one of the diagnosis codes listed in the current TMPPM Section 2.2.17.2.2. Providers will retain the responsibility of maintaining appropriate documentation for the nutritional products supplied. A retrospective review may be performed...

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11Dec

Texas Children’s Health plan provider and member portals

As a Texas Children’s Health Plan provider, you have access to the Texas Children’s Health Plan provider portal, called TouCHPoint. This portal can be used to check member eligibility, benefits, primary care provider selection, and claims status. To access Provider TouCHPoint, just log on to TexasChildrensHealthPlan.org/for-providers and find the TouCHPoint log-in on the right-hand side of the web page. Texas Children’s Health Plan members can access their own portal at TexasChildrensHealthPlan.org/for-members. The Member Portal allows your patients to play an active...

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07Dec

Dental caries and fluoride varnish: not just for dentists

Dental caries remains the most common chronic disease of childhood in the United States.  In fact, dental caries affects more than half of Texas children. Primary care providers play a key role in the prevention of dental caries. To help ensure dental health, all children 6 months of age and older should be referred to a dental home. Additionally, periodic oral evaluations and application of fluoride varnish in the medical home during well child or THSteps exams can help combat...

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02Dec

Authorization and Verification Process Updates

Authorization and Verification Process Updates                                   Texas Children’s Health Plan has made updates to the authorization process. Individual Member Fax Requests To ensure Health Insurance Portability and Accountability Act (HIPAA) compliance, providers must send one fax request per member with each fax having its own cover sheet. Requests received with multiple members per fax will be returned to the provider and not processed. Minimum Information Required to Process a Request Providers must use the Texas Standard Prior Authorization Request Form*, which can be found at...

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Provider Alert!
13Nov

Provider Alert! STAR Kids Billing Requirements

Attention: STAR Kids Providers REMINDER: STAR Kids Billing Requirements   As previously communicated, Texas Children’s Health Plan (TCHP) requires all STAR Kids providers billing for private duty nursing (PDN) services with the T1000 CPT code to use the billing matrix available on the Texas Health and Human Services website at https://hhs.texas.gov/laws-regulations/handbooks/star-kids-handbook/appendices/appendix-iii-ltss-billing-matrix-crosswalk. This requirement was effective June 5, 2017.   Failure to use this billing matrix, including placement of modifiers, will result in denials for incorrectly billed services.  Providers may receive line denials if all...

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15Oct

Improving Postpartum Hospital Discharge Education

In September 2018, the Texas Maternal Mortality and Morbidity Task Force released its latest report on deaths occurring during pregnancy and up to 1 year following the end of pregnancy.  Approximately 20% of maternal deaths occurred while the mother was pregnant or during the first 7 days after delivery!  Detailed maternal death case reviews revealed that “inadequate knowledge and lack of early recognition of postpartum complication signs frequently contributed to death.”1 Recommendations by the Task Force included that improvements be made...

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