HHSC

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!
26Feb

Provider Alert! HCPCS and CPT Code Prior authorization Update

Date: February 26, 2024 Attention: All Providers Effective date: January 1, 2024 Call to action: The purpose of this communication is to offer information about the Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) prior authorization updates. Resource: https://www.tmhp.com/sites/default/files/file-library/resources/rate-and-code-updates/hcpcs-updates/2024-hcpcs-special-bulletin.pdf How this impacts providers: Effective January 1, 2024 Texas Children’s Health Plan’s (TCHP's) prior authorization updates are listed below. These changes follow guidance from Texas Medicaid and Healthcare Partnership (TMHP). Medical necessity criteria for utilization review will be in accordance with Texas Medicaid...

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

Provider Alert! Prior Authorization Diagnosis Coding Reminder

Date: June 20, 2023 Attention: All Providers Call to action: As a reminder, Texas Children’s Health Plan (TCHP) aligns with the Texas Medicaid Provider Procedure Manual (TMPPM) regarding the ICD-10-CM diagnosis-coding requirement on claim submissions. Resource: TMPPM Section 6: Claims filing How this impacts providers: Diagnosis codes guidance as outlined in the TMPPM are as follows: Diagnosis codes must be to the highest level of specificity available Diagnosis codes must be appropriate for the age of the client as identified in the ICD-10-CM description of the...

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Provider Alert!
14Jun

Provider Alert! Member Eligibility Verification Methods and Information on Medicaid Billing!

Date: June 14, 2023 Attention: All Providers Member eligibility information: Texas Children’s Health Plan (TCHP) would like to remind providers that the Medicaid and/or CHIP coverage rules changed, beginning April 1, 2023. This means that some of our members will need to go through the process to determine their eligibility for coverage. Our members will be required to renew their Medicaid and/or CHIP coverage or risk losing their plan and access to healthcare. TCHP has actively communicated with members about this change...

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

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Provider Alert!
01Oct

Provider Alert! 90-Day Notice of EVV Compliance for Cures Act Personal Care Services Providers

Date: October 1, 2021 Attention: Financial Management Services Agencies and Consumer Directed Services employers Effective Date: January 1, 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: Effective January 1, 2022, the payers, Health and Human Servcies commission (HHSC) and TCHP, will begin Electronic Visit Verification...

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12Jun

Consumer Directed Services Employers Survey

For Providers: Consumer Directed Services Employers Survey Dear Consumer Directed Services employers, This notice is to inform you of a survey the Health and Human Services Commission (HHSC) Rate Analysis Department will release beginning Monday, June 15, 2020 and last through Wednesday, July 15, 2020. Click here to Learn More Click here to see more important Notices for Providers.

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Provider Alert!
11May

Provider Alert! Cures Act EVV: Required EVV Training Webinars in May and June

Attention: Financial Management Services Agencies (FMSA) Effective Date: 6/2/2020 – 6/3/2020 Call to action: In May and June, the Health and Human Services Commission (HHSC) and Texas Medicaid & Healthcare Partnership (TMHP) will hold live Electronic Visit Verification (EVV) policy and EVV Portal training webinars for program providers and financial management service agencies (FMSAs) required to use EVV by the Cures Act. How this impacts providers: Program providers and FMSAs affected by the Cures Act EVV expansion must complete EVV Portal training and EVV policy...

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26Apr

Appointment Availability Standards

Appointment availability standards What are appointment availability standards? How do you as a provider with Texas Children’s Health Plan play a role? In 2015 Senate Bill 760 passed, requiring Texas Health and Human Services Commission (HHSC) to monitor the provider networks of managed care organizations. Texas Children’s Health Plan would like to ensure members are able to schedule appointments with providers in accordance with the HHSC’s appointment accessibility guidelines.                                                 AFTER HOURS: Primary Care Physicians who are accessible 24 hours a day, seven days...

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Provider Alert!
01Feb

Provider Alert! Uniform Hospital Rate Increase Program (UHRIP)

Attn: STAR HOSPITAL SERVICES RE: Uniform Hospital Rate Increase Program (UHRIP) Dear Provider, The Texas Health and Human Services Commission (HHSC) has received approval from the Centers for Medicare and Medicaid Services to implement the Uniform Hospital Rate Increase Program (UHRIP) for hospital services effective March 1, 2018 for Harris and Jefferson Service Delivery Areas (SDAs).  State-owned hospitals and institutions for mental diseases are excluded from the program. Texas Children’s Health Plan (TCHP) will be sending a Letter of Agreement to all eligible hospitals...

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