Facilities

Articles with relevant information about Facilities.

Provider Alert!
06Jun

Provider Alert! Update to Age Requirement for Prior Authorization of Inotuzumab Ozogamicin (Besponsa)

Date: June 6, 2024 Attention: All Providers Effective for dates of service on or after: July 1, 2024 Call to action: The purpose of this communication is to inform providers that effective for dates of service on or after July 1, 2024, the age requirement for prior authorization of inotuzumab ozogamicin (Besponsa) (procedure code J9229) will be expanded to include pediatric and adult clients who are one year of age or older. How this impacts providers: Providers should reference the current Texas Medicaid Provider...

By Facilities, OB/GYNs, Office Managers, Pharmacy, Primary Care Providers, Provider Alert, Specialists, , , 0 CommentsRead more...
Provider Alert!
31May

Provider Alert! Updated National Drug Codes Added to Medicaid, CHIP Formularies

Date: May 31, 2024 Attention: Providers Effective date: May 8 and May 10, and May 16, 2024 Call to action: Texas Children’s Health Plan would like to inform providers that the Vendor Drug Program added the new drugs to the table available below, effective May 8, 2024, May 10, and May 16, 2024. National Drug CodeDrug NameEffective Date00173090442NUCALA 40 MG/0.4 ML SYRINGE5/8/202415370030560POKONZA 10 MEQ PACKET5/8/202464406003002ZURZUVAE 25 MG CAPSULE5/10/202464406003101ZURZUVAE 30 MG CAPSULE5/10/202468682013350CLINDAMYC-BNZ PEROX 1.2-3.75/10/202472786010202OXBRYTA 300 MG TABLET5/10/202472786010203OXBRYTA 300 MG TABLET5/10/202472205018138PIRFENIDONE 267 MG TABLET5/10/202459651020623NITROFURANTOIN 25 MG/5...

By Facilities, OB/GYNs, Office Managers, Pharmacy, Primary Care Providers, Provider Alert, Specialists, , , , 0 CommentsRead more...
Provider Alert!
28May

Provider Alert! Implementation of Hormonal Therapy Agents Clinical Prior Authorization

Date: May 28, 2024Attention: All Providers Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that on May 17, 2024 Health and Human Services Commission (HHSC) published an updated Hormonal Therapy Agents Clinical prior authorization criteria guide that was originally implemented on March 1, 2024. Previous TCHP provider alerts on hormonal therapy agents: Clinical Implementation of Hormonal Therapy Agents Clinical Prior Authorization Effective March 1, 2024: https://www.thecheckup.org/2024/02/02/provider-alert-clinical-implementation-of-hormonal-therapy-agents-clinical-prior-authorization-effective-march-1-2024/ Clinical Criteria Implementation for Enzyme Replacement Hormonal Therapy Agents effective May 1, 2024:...

By Facilities, OB/GYNs, Office Managers, Pharmacy, Primary Care Providers, Provider Alert, Specialists, , 0 CommentsRead more...
Provider Alert!
20May

Provider Alert! Maintenance Dialysis Benefits for Texas Medicaid Change

Date: May 20 2024 Attention: All Providers Effective Date: March 1, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective for dates of service on or after March 1, 2024, maintenance dialysis benefits changed for Texas Medicaid.  Maintenance Hemodialysis, IPD, CCPD, and CAPD The number of peritoneal dialysis treatments for continuous ambulatory peritoneal dialysis (CAPD) or continuous cycling peritoneal dialysis (CCPD) in the home is limited to 14 sessions within 31 days. This limit is set regardless of...

By Facilities, OB/GYNs, Office Managers, Pharmacy, Primary Care Providers, Provider Alert, Specialists, , , , , 0 CommentsRead more...
Provider Alert!
20May

Provider Alert! Texas Children’s Health Plan’s has a new Fraud, Waste, and Abuse Hotline

Call to action: We would like to introduce Texas Children's Health Plan's (TCHP) new Fraud, Waste, and Abuse Hotline, a dedicated resource designed specifically for our Network Providers. We understand the critical importance of maintaining the highest standards of integrity and compliance within our healthcare network. The New Hotline is 866-828-4924, or visit https://tchpintegrity.com/. How this impacts providers: Our hotline offers a secure and confidential way for providers to report any issues or concerns related to compliance, fraud, waste, or abuse. Whether...

By Facilities, OB/GYNs, Office Managers, Pharmacy, Primary Care Providers, Provider Alert, Specialists, , , 0 CommentsRead more...
Provider Alert!
14May

Provider Alert! Chikungunya Virus Vaccine Is Now a Benefit of Texas Medicaid

Date: May 14, 2024 Attention: All Providers Effective Date: April 1, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective for dates of service on or after April 1, 2024, the chikungunya virus vaccine (procedure code 90589) is now a benefit of Texas Medicaid for clients who are 19 years of age or older. Procedure code 90589 may be reimbursed for the following provider types and places of service: Place of ServiceProvider TypeOfficePhysicians, Physician assistants, nurse practitioners, clinical...

By Facilities, OB/GYNs, Office Managers, Pharmacy, Primary Care Providers, Provider Alert, Specialists, , , 0 CommentsRead more...
Provider Alert!
14May

Provider Alert! Vaccine Services Procedure Code 90623 is Now Available Through TVFC

Date: May 14, 2024 Attention: All Providers Effective Date: April 1, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective for dates of service on or after April 1, 2024, vaccine services procedure code 90623 is now available through the Texas Vaccines for Children (TVFC) program for clients who are 10 years through 18 years of age. Note: Procedure codes for vaccines distributed by the Texas Vaccines for Children Program are processed as Informational on Texas Medicaid fee-for-service...

By Facilities, OB/GYNs, Office Managers, Pharmacy, Primary Care Providers, Provider Alert, Specialists, , 0 CommentsRead more...
Provider Alert!
09May

Provider Alert! Change in Preferred Drug List Status for Lincosamides/Oxazolidinones/Streptogramins Drug Class

Date: May 9, 2024 Attention: All Providers Effective date: May 7, 2024 Call to action: Effective May 7, 2024, the Texas Health and Human Services (HHS) removed non-preferred status from generic linezolid suspension products. This is in response to the long term back order of the brand product Zyvox by the manufacturer. The preferred status of the brand name Zyvox will not change to allow any current stock to be used. How this impacts providers: The change will allow providers to prescribe the generic without...

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