Primary Care Providers

Articles with relevant information for Primary Care Providers (PCP).
10Sep

What is the Medically Dependent Children’s Program (MDCP) waiver?

If you have STAR Kids patients, there’s a chance some of them receive the Medically Dependent Children’s Program (MDCP) waiver, which is a home and community based services program. The goal of this program is to support families and children by preventing institutionalization and hospitalization, while helping them remain safely in their homes with the appropriate services. Examples of these services include: Flexible family support service Respite care Minor home modifications Adaptive aids Transition assistance services Employment assistance Supported employment Financial management services The purpose of enrolling a child...

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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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10Aug

Improving Access to SBIRT

Improving Access to Screening, Brief Intervention, and Referral to Treatment in Primary Care for Adolescents: A Resource Center From the Center for Health Care Strategies, Inc. (CHCS) Adolescence is often a period for risky behavior and experimentation with alcohol and drugs. An estimated 70 percent of high school students have tried alcohol and 49 percent of high school seniors have used an illegal drug at least once. As a population, adolescents are more vulnerable than adults are to addiction. Early identification of...

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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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11Jul

Texas Children’s Health Plan increases yearly gastrostomy button (G-button) limits

A message from Dr. Katy Ostermaier, Medical Director of STAR Kids at Texas Children’s Health Plan Texas Children’s Health Plan is pleased to announce an increase in gastronomy button (G-button) limits per year. As of February 26, 2019, we now allow 6 G-buttons to be dispensed per year. Families who have children with G-buttons can have a hard time getting the supply of replacement G-buttons needed when they break. An active child may need to replace broken G-buttons often, but Texas Medicaid...

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16Jun

For STAR Kids providers: Updated ANE Reporting Process

This requirement is effective September 1, 2018, and the updates have now been made in the UMCM – see Resources below.   As of September 1, 2018, all Texas Children’s Health Plan-contracted providers of Medically Dependent Children Program (MDCP) services are required to report all critical incidents, including Abuse, Neglect, and Exploitation (ANE), to the health plan. This action is to meet federal requirements regarding critical incident reporting (see links to federal requirements for incident reporting in below ‘Resources’ section).   MDCP providers contracted...

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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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21May

The YES Waiver for Medicaid Members: What You Need to Know

What is the YES Waiver? The Youth Empowerment Services (YES) Wavier is a Medicaid program that helps youth ages 3-18 years old with serious developmental, emotional, and behavioral difficulties. The YES waiver provides intensive services delivered within a strengths-based team planning process called wraparound. Wraparound builds on family and community support to build a family’s natural support network and connection with the community. The goal of the YES Waiver is to prevent out of home placement. It is a short-term waiver...

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10May

Perspectives on E-Cigarettes Webinar

If you take care of children in your practice, or have children of your own who are or will be teenagers, check out the American Thoracic Society’s latest webinar on e-cigarettes: “Perspectives on E-Cigarettes”. Presented by toxicologist Dr. Ilona Jaspers, PhD, this webinar will: Equip you with knowledge and strategies to deter teenagers from nicotine addiction and Provide helpful information on adolescents and e-cigarette use that you can incorporate into your practice Click here to view the webinar now!

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