Primary Care Providers

Articles with relevant information for Primary Care Providers (PCP).
15Mar

Meet Our New President

Lou Fragoso has been appointed president of Texas Children’s Health plan. He joined Texas Children’s Pediatrics in February 2014 and was vice president of Business Operations. Prior to joining Texas Children’s, Lou was in leadership roles at Baylor College of Medicine in Houston and at Lurie Children’s Hospital in Chicago. Lou is a Certified Public Accountant with over 20 years of healthcare finance and management experience. Since joining Texas Children’s Pediatrics, Lou spearheaded the creation of Texas Children’s Urgent Care. Texas...

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14Mar

New Texas Children’s Health Plan provider portal features added

Texas Children’s Health Plan has been actively adding new features to the provider portal located at www.tchp.us/providers Providers can continue to view eligibility, claim status, authorizations and all of our provider news. In addition, providers are able to view the named Service Coordinator for STAR Kids members and submit claim appeals online. The named Service Coordinator for STAR Kids members can be found on the member enrollment information screen under additional information. The Texas Children’s Health Plan Service Coordinator serves as the...

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12Mar

Attention: Star Kids Providers: Prior Authorization required on all Vendor Drug Program (VDP) identified medications

Texas Children’s Health Plan requires prior authorization (PA) on all medications on the VDP website prior to dispensing to members. To obtain a list of medications requiring prior authorization, visit the VDP website at: http://www.txvendordrug.com/formulary/preferred-drugs.shtml Providers can also view instructions on accessing and using the formulary at the Texas Children’s Health Plan website: http://www.thecheckup.org/2016/06/09/do-you-know-how-to-access-the-texas-childrens-health-plan-formulary/ Providers can submit PA documentation to Texas Children’s Health Plan’s pharmacy benefit manager, Navitus. PA forms can be found here: https://www.navitus.com/texas-medicaid-star-chip/prior-authorization-forms.aspx Prior authorizations need to be submitted to Navitus by faxing to...

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13Feb

What is the role of STAR Kids Service Coordinators?

A Service Coordinator is the central contact between Texas Children’s Health Plan and a member’s providers and family members. The purpose of a Service Coordinator is to maximize a Member’s health, wellbeing and independence. The Service Coordinator must work with the Member’s PCP to coordinate all of a member’s health services. The STAR Kids Service Coordinator also engages as an advocate and intervenes on behalf of the member if approved by the member. The Service Coordinator will perform an overall evaluation...

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13Feb

AAP Strongly Advises Against Codeine for Children

The American Academy of Pediatrics (AAP) has recently released a Clinical Report strongly advising against codeine use in children. The rationale of the AAP is as follows: “Codeine is a prodrug with little inherent pharmacologic activity and must be metabolized in the liver into morphine, which is responsible for codeine’s analgesic effects. However, there is substantial genetic variability in the activity of the responsible hepatic enzyme, CYP2D6, and, as a consequence, individual patient response to codeine varies from no effect to...

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13Feb

Know When to Prescribe an Antiviral

Vaccination Flu season is back and vaccinating continues to be the best way to protect ourselves and our patients against serious complications from the flu.[1] Patients should only receive the intramuscular vaccine; intranasal flu vaccine is not effective for the 2016-2017 flu season.1 Patients 17 and younger should be offered the flu vaccine during office visits, while those 18 years and older also have the option of receiving it at pharmacies. Treatment (Antiviral and Supportive) Patients who are high risk for complications and...

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01Feb

HEDIS Spotlight: Prenatal / Postpartum Care

HEDIS stands for Healthcare Effectiveness Data and Information Set. It is a widely used set of performance measures by the nation’s health plans, and an essential tool in ensuring that our members are getting the best healthcare possible. It is extremely important that our providers understand the HEDIS® specifications and guidelines. In this section of The Checkup we will highlight different HEDIS metrics. We will provide a description of the measures, the correct billing codes to support services rendered and...

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17Jan

HHSC Notice! THSteps Documentation Improvement

Dear Texas Health Steps Provider: CHARLES SMITH EXECUTIVE COMMISSIONER As a Texas Health Steps (THSteps) provider, you affect the lives of many young Texans, and the Health and Human Services Commission (HHSC) understands documenting the THSteps components of the checkup can be challenging. One federal and two state contracted reviews of medical records have shown that missing documentation is the largest factor and the primary cause of records being reviewed and money being recouped. HHSC would like to assist you in documenting all...

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22Dec

Texas Children’s Health Plan’s Chief Medical Officer Named ACOG President-Elect

Houston—Lisa Hollier, MD, MPH, Chief Medical Officer for Obstetrics and Gynecology for Texas Children’s Health Plan and Medical Director for The Center for Children and Women, has been selected President-elect of the American College of Obstetrics and Gynecologists to serve the May 2017-May 2018 term. She will take office at the Executive Board Meeting on May 9, 2017. Hollier is also a professor of Obstetrics and Gynecology and director of the Division of Women’s Health Policy at Baylor College of Medicine....

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