Provider Alert

Articles with information about Provider Alerts.

Provider Alert!

Provider Alert! Availity Now Offered to Providers for Electronic Claims Submission

Date: March 26, 2024 Attention: All Providers Effective Date: March 25, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to announce that Availity is now available as a clearinghouse option for electronic claims submissions. Getting Started with Availity: If a provider already uses Availity as a clearinghouse, then claims will route to TCHP payer IDs as normal (payer ID information can be found in the TCHP Institutional Guide and TCHP Professional Guide). No additional action is required. If a provider uses Change Healthcare...

Provider Alert!

Provider Alert! UPDATED: Notification of CORF/ORF Reimbursement Policy

Date: March 22, 2024 Attention: Comprehensive Outpatient Rehabilitation Facility (CORF) and Outpatient Rehabilitation Facility (ORF) Providers Effective Date: June 1, 2024 Call to action: The purpose of this communication is to make providers aware of a new reimbursement policy for Texas Children’s Health Plan (TCHP), which outlines the billing requirements for Comprehensive Outpatient Rehabilitation Facility (CORF) and Outpatient Rehabilitation Facility (ORF) provider types. This policy applies to CHIP and Medicaid lines of business. This policy does not apply to ECI, Home Health, Individual...

Provider Alert!

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...

Provider Alert!

Provider Alert! Sleep Studies no longer require Prior Authorization

Date: March 22, 2024 Attention: All Providers Effective date: February 7, 2024 Call to action: Effective for dates of service on or after February 7, 2024, Texas Children’s Health Plan (TCHP) will not require a prior authorization for sleep studies. Disclaimer: It is the responsibility of the Provider to verify that a service is a benefit of Texas Medicaid for service codes that TCHP does not require prior authorization. Services rendered by out-of-network providers will require prior authorization. TCHP would like to remind providers that...

Provider Alert!

Provider Alert! Annual HEDIS ® Medical Record Review Process has started

Date: March 19, 2024 Attention: Primary Care Providers Review Period: Now through April Call to action: TCHP would like to inform network providers that the HEDIS® medical record data review process began in February 2024 and will proceed through April 29, 2024. Additionally, we have contracted with Inovalon, Inc. to retrieve medical records and perform HEDIS® medical record data abstraction on our behalf. All medical records must be in to Inovalon by Monday, April 29, 2024. Please note the following: Inovalon serves as TCHP’s...

Provider Alert!

Provider Alert! Omnipod 5 Added to Medicaid and CHIP Formularies

Date: March 18, 2024 Attention: All Providers Effective date: February 22, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective February 22, 2024, the Texas Health and Human Services (HHSC) allows coverage for Omnipod 5 through pharmacy benefit for both CHIP and Medicaid formularies. Members can obtain one (1) Omnipod 5 G6 intro kit per 365 days, and fifteen (15) units of Omnipod 5 C6 PODS per 30 days. HHSC is not requiring clinical prior...

Provider Alert!

Provider Alert! EVV Claims Matching Resumes April 1, 2024; Unmatched EVV Claims will Deny for Payment

Date: March 7, 2024 Attention: STAR Kids Providers/Consumer Directed Services employers and FMSA Providers Effective Date: April 1, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that Texas Health and Human Services Commission (HHSC) implemented a claim matching bypass on February 1, 2024 – for Electronic Visit Verification (EVV) claims with dates of service from January 1 through March 31 – to be paid without a matching EVV visit. EVV claims matching for all services required to use...

Provider Alert!

Provider Alert! Updates to HHAeXchange Training Resources

Date: March 4, 2024 Attention: EVV Program Providers and FMSAs Call to action: Texas Children’s Health Plan (TCHP) would like to make providers aware that HHAeXchange has updated its training resources available for Electronic Visit Verification (EVV) program providers and financial management services agencies (FMSAs) that use the HHAeXchange Portal as their EVV system. How this impacts providers: The updated training resources, located on the HHAeXchange webpage, include: HHAX Provider Portal FAQs (PDF) HHAX EVV Aggregation Transaction Manager Rule Holds and Resolutions (PDF) Next step for...

Provider Alert!

Provider Alert! Important Information for Checks Dated February 27, 2024

Date: March 4, 2024 Attention: All Providers Call to action: As noted in our Provider Alert dated February 26, 2024, Texas Children’s Health Plan (TCHP) has activated an alternative payment process that will be in effect until Optum’s Change Healthcare process is restored.  The referenced alert is available here. How this impacts providers: Errors have been identified in the checks dated and mailed February 27, 2024. Please do not deposit these checks and destroy them when received. Checks dated February 27, 2024 have...

Provider Alert!

Provider Alert! Texas Children’s® Link, Online Provider Portal Claim Submission Guidance

Date: March 1, 2024 Attention: All Providers Call to action: In response to Optum’s recent Change Healthcare network interruption, Texas Children’s Health Plan (TCHP) would like to provide details on the claim submission methods currently available. Where can providers submit claims: The most efficient option is submitting claims and appeals through Texas Children's® Link, our provider portal https://epiccarelink.texaschildrens.org/ The batch claim submission process is available on the portal, where 837 files can be uploaded directly onto Texas Children's® Link. To access this from Texas Children's® Link,...