News Blog
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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Provider Alert!
13Oct

Provider Alert! Reminder – LTSS Enrollment Deadline Extended to October 31, 2018

Attention:  Long Term Services and Supports Providers (LTSS) Subject:  Reminder - Enrollment Deadline Extended to October 31, 2018   This is a reminder that the enrollment deadline for Long Term Support Services (LTSS) providers serving MCO members is quickly approaching. Long Term Support Services (LTSS) providers serving MCO members are required to enroll through the Medicaid MCO LTSS provider enrollment process.   To allow sufficient time for application processing, MCO LTSS providers are strongly advised to submit applications as soon as possible.   An MCO LTSS Provider...

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12Oct

Updating Texas Children’s Health Plan Member Change of Address Information

All address changes must be reported to HHSC. Members can contact HHSC by calling 2-1-1 or by updating their account on YourTexasBenefits.com. It is important to make sure address information is updated in a timely manner to ensure families continue to receive information from Texas Children’s Health Plan and HHSC. If a member has moved to an area that is not covered by Texas Children’s Health Plan, they will need to select a new health plan. If a family is...

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Provider Alert!
12Oct

Provider Alert! Texas Children’s Health Plan Claim Editing System Update

Attention:  All Providers Subject: Texas Children’s Health Plan Claim Editing System Update Effective: 12/27/2018   Texas Children’s Health Plan intends to transition to a new Claims Editing System (CES) by Optum on 12/27/2018. Please be aware that claims submitted prior to 12/27/2018 will continue to be processed by our current vendor, McKesson Claim Check. TCHP is required by Texas Health and Human Services to ensure all required claims edits are consistently applied. Migrating to Optum CES will enable TCHP to efficiently apply all required coding...

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Provider Alert!
12Oct

Provider Alert! Neonatal Level of Care Designation Updates

Date: August 28, 2018 Attention:  All Hospitals  Subject:  Neonatal Level of Care Designation Updates Effective for dates of service on or after September 1, 2018, hospitals enrolled in Texas Medicaid may be reimbursed for inpatient neonatal services only if the hospitals have received a neonatal level of care designation from the Department of State Health Services (DSHS) in accordance with 25 Texas Administrative Code §§133.181-133.190. Requirements: Hospitals with neonatal units must have a level of care designation.  Information on these requirements and an application can...

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