Facilities

Articles with relevant information about Facilities.

Provider Alert!
12Apr

Provider Alert! Livmarli Clinical Prior Authorization Criteria Revision Scheduled for May 30, 2023

Date: April 11, 2023 Attention: All Providers Effective Date: May 30, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective May 30, 2023, the Health and Human Services Commission (HHSC) will update prior authorization criteria for Livmarli that meets the recent FDA-approved age indication. How this impacts providers: Starting May 30, 2023, TCHP will expand the age requirement to pediatric patients three months and older. Next steps for providers: Prescribers should share this communication with their staff. Provider...

By Facilities, HHSC, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialists, , , 0 CommentsRead more...
Provider Alert!
12Apr

Provider Alert! Appealing Legacy Claims within our Provider Portal, Texas Children’s Link

Date: April 10, 2023 Attention: All Providers Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers utilizing Texas Children’s Link, our online provider portal, how to access and appeal legacy claims within this platform. Legacy Claims are defined as claims with a submission date prior to August 1, 2022.   Click here for the steps to access and appeal legacy claims. We hope this option improves your daily operations and makes the claims reconciliation process much easier. Background information: Texas...

By Facilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialists, , , 0 CommentsRead more...
Provider Alert!
11Apr

Provider Alert! FDA Withdrawal of Makena®

Date: April 10, 2023 Attention: All Providers Effective Date: April 06, 2023 Call to action: Effective April 6, 2023, the U.S. Food and Drug Administration (FDA) announced the final decision to withdraw the approval of Makena and its generics, which was approved to reduce the risk of preterm birth in women pregnant with one baby who have a history of spontaneous preterm birth. Makena and its generics are no longer FDA approved and cannot be lawfully distributed. This is in result due to...

By Facilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialists, , , , 0 CommentsRead more...
Provider Alert!
10Apr

Provider Alert! Clinical Criteria for Xenpozyme Procedure Code J0218 effective May 1, 2023

Date: April 6, 2023 Attention: All Providers Effective Date: May 1, 2023 Call to action: Effective May 1, 2023, the Health and Human Services Commission (HHSC) will begin the incorporation of prior authorization criteria for Xenpozyme (procedure code J0218) to the Enzyme Replacement Therapy policy. Xenpozyme is the first therapy indicated specifically for the treatment of non-central nervous system manifestations of acid sphingomyelinase deficiency (ASMD) in adult and pediatric patients, and is currently the only approved treatment for this disease. Authorization Requirements 1. Member has...

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Provider Alert!
23Mar

Provider Alert! UPDATE: Recent Claim Denials Issued in Error are now Corrected

Date: March 23, 2023 Attention: All Providers Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that we have corrected the internal system error that was previously reported. The error impacted claims processing beginning February 27- March 7, 2023. All impacted claims from this time span have been reprocessed. The erroneous EOP message related to these claims was, “This Provider was not certified/eligible to be paid for this procedure/service on this date of service.” Claims impact report: Your assigned...

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10Feb

Provider Alert! COVID-19 Vaccine Administration Procedure Codes 0164A and 0173A are Now Benefits of Medicaid and CHIP

Date: February 10, 2023  Attention: All Providers Effective date: Dates of service on or after December 8, 2022 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event. Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective for dates of service on or after December...

By Facilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialists, , , 0 CommentsRead more...
01Feb

Case Management for Children and Pregnant Women (CPW) COVID-19 Flexibilities

Date: February 1, 2023 Attention: All Providers Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event. Call to action: Texas Children’s Health Plan (TCHP) would like to make providers aware of direction from Texas Health and Human Services Commission (HHSC) regarding the Case Management for Children and Pregnant Women...

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30Jan

Provider Alert! CHIP co-pays waived for office visits in response to COVID-19

Date: January 30, 2023       Attention: All Providers Effective Date: January 30, 2023 The content in this message will remain in effect through April 30, 2023 as announced by the Health and Human Services Commission.TCHP COVID-19 Utilization Management Procedure and provider alerts can be found here: http://www.thecheckup.org/provider-alerts/ Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the...

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Provider Alert!
05Jan

Provider Alert! Prior Authorization Criteria Update for Amvuttra

Date: December 29, 2022 Attention: All Providers Effective date: February 1, 2023 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event. Call to action: Effective, February 1,2023, the Texas Health and Human Services Commission (HHSC) will update the prior authorization criteria for Amvuttra (procedure code J0225). Amvuttra (vutrisiran) is a transthyretin-directed...

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Provider Alert!
05Jan

Provider Alert! Medicaid Preferred Drug List and Formulary Changes

Date: December 29, 2022 Attention: Providers Effective Date: January 26, 2023 Call to action: Effective January 26, 2023, select medication(s) moved from “preferred” to “non-preferred” status and vice-versa. Texas Children’s Health Plan wants to notify providers so that these changes do not impact the ability of your STAR and STAR Kids members to obtain their medications.  A summary of the changes is included below. Resource: https://www.txvendordrug.com/formulary/preferred-drugs Changes with biggest impact to Texas Children Health Plan members and providers: MedicationTypePreferred alternativesCiproflaxacin suspension [G]AntibioticCipro suspension [B]E.E.S. (erythromycin) granules...

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