Facilities

Articles with relevant information about Facilities.

Provider Alert!

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...

Provider Alert!

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...

Provider Alert!

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...

Provider Alert!

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...

Provider Alert!

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...

Provider Alert!

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...

Provider Alert!

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...

Provider Alert!

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...

Provider Alert!

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...

Provider Alert!

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...