Facilities

Articles with relevant information about Facilities.

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!
29Feb

Provider Alert! Notification of Observation/Treatment Room and E&M Services Reimbursement Policy

Date: February 29, 2024 Attention: Hospital facilities Effective Date: May 27, 2024 Call to action: The purpose of this communication is to make hospital facilities aware of a new reimbursement policy for Texas Children’s Health Plan (TCHP), which outlines the billing restrictions for observation and treatment room revenue codes billed with evaluation and management (E&M) services.  This policy applies to hospitals billing outpatient services, and applies to CHIP and Medicaid lines of business. How this impacts providers: Policy guidelines are as follows:Observation and treatment...

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Provider Alert!
27Feb

Provider Alert! Coverage of Elevidys Begins January 2024

Date: February 27, 2024 Attention: All Providers Prior authorization effective date: February 1, 2024 Call to action: The purpose of this communication is to inform providers that on January 1, 2024, Elevidys became a benefit of Medicaid and CHIP. Texas Health and Human Services Commission (HHSC) requires prior authorization for Elevidys (procedure code J1413) for Medicaid and CHIP, effective February 1, 2024. Elevidys is an adeno-associated virus vector-based gene therapy indicated for the treatment of ambulatory pediatric clients ages 4 through 5 years with...

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Provider Alert!
17Nov

Provider Alert! Timeframe for follow-up from an Inpatient Behavioral Health Facility

Date: November 17, 2023 Attention: Behavioral Health Providers and inpatient facilities Call to action: Texas Children’s Health Plan (TCHP) request that all members receiving inpatient psychiatric services be scheduled prior to discharge for outpatient or lower level of care follow-up with an in network behavioral health provider. To search for TCHP network behavioral health providers, click here. The timeframe requirements are as follows: Initial outpatient treatment after discharge must occur within seven (7) days from the date of discharge. The appointment should not occur...

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Provider Alert!
21Sep

Provider Alert! Billing Updates for Envolve Vision

Date: September 19, 2023 Attention: All Providers Effective Date: October 1, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to remind you that Envolve Vision provides vision coverage for our CHIP, STAR and STAR Kids members up to 18 years old. For your awareness, Envolve Vision's Clinical Policy for Routine (Preventive) Eye Examination (OC.UM.CP.0013) has recently been updated. The following changes will take effect for claims submitted on or after October 1, 2023: Headache codes R51.0 and R51.9 have been removed from...

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Provider Alert!
29Aug

Provider Alert! Medicaid Re-enrollment: Patients May Risk Losing Their Medicaid Plan!

Date: August 28, 2023 Attention: All Providers Call to action: Texas Children’s Health Plan (TCHP) would like to thank you for supporting your patients with maintaining coverage during the Medicaid re-enrollment currently underway. Background information: As you may know, Medicaid coverage rules have changed, and some Medicaid recipients need to go through the renewal process to determine their eligibility for coverage. This is the result of the Consolidated Appropriations Act, 2023 (CAA, 2023) that was enacted on December 29, 2022. The CAA ended the...

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Provider Alert!
18Aug

Provider Alert! Member Experience Survey Coming Soon

Date: August 17, 2023 Attention: All Providers Effective Date: August 2023 Call to action: Texas Children Health Plan (TCHP) would like to let providers know that later this month your patients may be given a member experience survey. The survey will include questions in regards to, but not limited to, communication, care coordination and access to care. Participation in this survey is voluntary. How this impacts providers: Members’ responses will help create effective, active interventions where we hope to partner with you and better...

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Provider Alert!
16Aug

Provider Alert! Healthy Rewards/Value Added Services for 2023-2024

Date: August 16, 2023 Attention: All Providers Effective Date: September 1, 2023 Call to action: Texas Children’s Health Plan (TCHP) is proud to present our Healthy Rewards Program/Value Added Services (VAS) program effective September 1, 2023 through August 31, 2024. These rewards and services are available in each line of business CHIP, STAR, and STAR Kids and Service Delivery Areas; Harris, Jefferson and North East (limitations may apply). Member favorites, such as the Prenatal and Postpartum Visit Rewards, Portable Crib/Playpen, Diabetes Management Rewards and...

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Provider Alert!
07Aug

Provider Alert! Implementation of Sotyktu Criteria in Cytokine and CAM Antagonists Clinical Prior Authorization

Date: August 4, 2023 Attention: All Providers Effective Date: July, 27 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective July, 27 2023, the Texas Health and Human Services Commission (HHSC) implemented criteria for Sotyktu®. Sotyktu® belongs to the Cytokine and CAM Antagonists class and is indicated for the treatment of moderate-to-severe plaque psoriasis in adults who are candidates for systemic therapy or phototherapy. How this impacts providers: The new criteria is available on the HHSC...

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