OB/GYNs

Articles with relevant information for OB/GYNs

Inovalon
07Oct

Understand your patients’ care gaps and improve your quality of care with the Inovalon HEDIS® Metrics Tool

Texas Children’s Health Plan PCPs and OB/GYN providers can now access data via the Inovalon HEDIS Metrics Tool through our Provider Portal. This new tool allows you to use performance and patient data so that you can independently manage your patient population, as well as improve the quality of disease management throughout your panel. Key features such as member-level gap reports and detailed HEDIS quality rates contribute to improving your provider incentive program rates. If you have any questions about Inovalon...

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Provider Alert!
01Oct

Provider Alert! DME/equipment/supplies exceeding Texas Medicaid Limitations

Effective October 1, 2019, Texas Children’s Health Plan will implement a prior authorization process for providers to request prior approval to provide DME/Equipment/Supplies to members 20 years of age and under in excess of benefit limitations. Texas Children’s Health Plan applies benefit limitations for DME/Equipment/Supplies in accordance with the Texas Medicaid Provider Procedure Manual (TMPPM) for all members eligible to receive the benefit, except for the following:   Next steps for providers: DME/Equipment/Supplies for a member who is 20 years of age or younger...

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21Sep

What does Service Coordination mean for your STAR Kids patients?

As a provider, you may have questions regarding the role Service Coordination plays in the lives of your STAR Kids patients. At Texas Children’s Health Plan, the goal of Service Coordination is to optimize health to ensure that the member’s tomorrow is better than his or her today. Service Coordination is a person-centered approach to care. Each of our members is assigned an appropriately licensed Service Coordinator. Our Service Coordinators are responsible for the following: Providing each member with initial and...

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21Aug

UPDATE: Provider Portal/Health Effectiveness Data and Information Set (HEDIS)

We are still working on this portion of the Provider Portal project to bring you accurate, timely data so you can best manage your patients’ health. Please check our Provider Portal homepage for updates. Contact your provider relations manager to obtain your current HEDIS performance. Their contact information is available on our website, texaschildrenshealthplan.org on the For Providers page titled Meet our Team. It is also available on the Provider Portal at healthtrioconnect.com

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15Aug

No-cost sports and school physicals for CHIP and Medicaid patients

It’s back-to-school season, which means your patients will need to complete their annual sports and school physicals. As a value added service through our Healthy Rewards Program, CHIP and STAR patients ages 5 to 19 years and STAR Kids patients under 21 years can receive a no-cost sports and school physical if they have completed a Texas Health Steps or well-child visit within the last 12 months. Providers will be reimbursed for the cost of the sports and school physical. For...

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13Aug

Prenatal and postpartum care: best practices and professional guidelines for CHIP providers

Texas Children’s Health Plan encourages providers to follow best practices and professional guidelines. To assist in this, refer to the following reminders about covered benefits under Children’s Health Insurance Program (CHIP) and CHIP-Perinatal (CHIP-P): Prenatal Care The Centers for Disease Control and Prevention (CDC), American College of Obstetricians and Gynecologists (ACOG), and American Academy of Pediatrics (AAP) all concur that immunization against Tetanus, Diphtheria, and Acellular Pertussis (Tdap) protects the perinate from morbidity and mortality attributable to pertussis infection1. Based on this guidance, the...

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07Aug

Appointment Availability Standards for Primary Care and OB

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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01Aug

Flu protection for two: the importance of the flu vaccine during pregnancy

Influenza vaccination is an essential element of pre-pregnancy, prenatal, and postpartum care because influenza can result in serious illness, including a higher chance of progressing to pneumonia, when it occurs during the antepartum or postpartum period. In addition to hospitalization, pregnant women with influenza are at increased risk of intensive care unit admission and adverse perinatal and neonatal outcomes. The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices and the American College of Obstetricians and Gynecologists recommend that...

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11Jun

OB/GYN 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.                   **Texas Children’s Health Plan periodically surveys each participating provider to ensure that members are able to...

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01Jun

The new and improved Provider Portal is here!

The upgraded Texas Children’s Health Plan Provider Portal is now live! We have worked to bring a revamped user experience to our entire provider network. Our goal is to empower our providers with the tools to access accurate, timely data, so that they are able to deliver the best possible care to our members and their families. The redesigned portal features: Improved functionality for the claims, appeals, and messaging center Health Management Tools menu Access to Healthcare Effectiveness Data and Information Set (HEDIS®) data...

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