Specialists

Articles with relevant information for Specialists.

Provider Alert!
18Apr

Provider Alert! Clinical Criteria Implementation for Enzyme Replacement Hormonal Therapy Agents effective May 1, 2024

Date: April 18, 2024 Attention: All Providers Effective Date: May 1, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective May 1, 2024, the Texas Health and Human Services (HHSC) will implement clinical prior authorizations to Adzynma (procedure code C9167) and Pombiliti (procedure code J1203) to the Enzyme Replacement Therapy (ERT) policy. Prior Authorization Requirements  Apadamtase alfa (Adzynma), procedure code C9167 is indicated to treat the following:  Pediatric and adult clients for prophylactic or on-demand ERT for congenital...

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Provider Alert!
18Apr

Provider Alert! Early Childhood Intervention (ECI) and Telehealth Services are not required to Use EVV

Date: April 17, 2024 Attention: Early Childhood Intervention and Telehealth Service Providers Effective date: January 1, 2024 Call to action: The purpose of this communication is to inform applicable service providers that Early Childhood Intervention (ECI) and home health services delivered via Telehealth are not required to use EVV for dates of service on or after January 1, 2024. Background: The Cures Act required states to implement Electronic Visit Verification (EVV) for Medicaid home health care services (HHCS) by Jan. 1, 2023. However, in...

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Provider Alert!
15Apr

Provider Alert! EVV Program Providers and FMSAs: Register for HHAeXchange Town Hall Webinars April 25 and May 30

Date: April 12, 2024 Attention: STAR Kids Providers/Consumer Directed Services employers, and FMSA Providers Call to action: Texas Children’s Health Plan (TCHP) would like to let program providers and financial management services agencies (FMSAs) know about the upcoming Electronic Visit Verification (EVV) Town Hall Webinar on Thursday, April 25, and Tuesday, May 30 from 1–3 p.m. (Central time). Agenda Overview of the EVV Transition EVV System Enhancements Addressing Key Concerns and Frequently Asked Questions Support Resources Q&A Session Click here to register. Next step for Providers: Providers are encouraged to share this communication...

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Provider Alert!
12Apr

Provider Alert! EVV Home Health Care Services (HHCS) Service Bill Codes Table Update Version 2.1

Date: April 12, 2024 Attention: STAR Kids Providers/Consumer Directed Services employers, and FMSA Providers Call to action: Texas Children’s Health Plan (TCHP) would like to inform applicable providers that a new version of the electronic visit verification (EVV) Health and Human Services (HHCS) Bill Codes Table has posted. The table is on the EVV 21st Century Cures Act webpage in Excel and PDF formats. Background:Effective January 1, 2024, Electronic Visit Verification (EVV) is required for Medicaid home health care services (HHCS). Program providers and financial management services agencies (FMSAs)...

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Provider Alert!
04Apr

Provider Alert! New Prior Authorization Resource to Determine Dates of Service

Date: April 3, 2024 Attention: All Providers Call to action: The purpose of this communication is to inform providers of a new resource available from Texas Medicaid and Healthcare Partnership (TMHP) available at https://www.tmhp.com/topics/prior-authorization/pa-calculator.  It is included on the TMHP prior authorization webpage. Providers are encouraged to utilize this calculator to calculate the dates of service that must be applied to the prior authorization form/prior authorization request.  By accessing TMHP’s tool, providers will save time and avoid having to resubmit or correct authorizations...

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Provider Alert!
02Apr

Provider Alert! TCHP Member Transportation Vendor Update

Date: April 2, 2024 Attention: All Providers Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that our former Member medical transportation provider, Veyo has transitioned to Medical Transportation Management (MTM). MTM operates both Non-Emergent Medical Transportation (NEMT) and Value Added Services (VAS) rides for Members. Members or your staff will still call the same number to schedule rides, 1-888-401-0170. Best of all, the transportation benefits will remain the same. As a reminder, the process for members to schedule...

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Provider Alert!
29Mar

Provider Alert! EVV Policy Updates Now Available for the Mobile Method Geo-Perimeter Expansion

Date: March 29, 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 Texas Health and Human Services Commission (HHSC) has posted the new and revised policies for mobile method effective April 1, 2024, that will be added to the Electronic Visit Verification (EVV) Policy Handbook in an upcoming handbook revision. These new and revised policies are outlined in the Increase in Geo-Perimeter...

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Provider Alert!
27Mar

Provider Alert! EVV Program Providers and FMSAs: Register for HHAeXchange Town Hall Webinar Thursday, March 28

Date: March 27, 2024 Attention: STAR Kids Providers/Consumer Directed Services employers and FMSA Providers Call to action: Texas Children’s Health Plan (TCHP) would like to let program providers and financial management services agencies (FMSAs) know about the upcoming Electronic Visit Verification (EVV) Town Hall Webinar on Thursday, March 28, from 1–3 p.m. (Central time). Agenda Overview of the EVV Transition EVV System Enhancements Addressing Key Concerns and Frequently Asked Questions Support Resources Q&A Session Register Now. Next steps for providers: Providers are encouraged to share this communication with their staff. If you...

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Provider Alert!
26Mar

Provider Alert! Billing EVV Services as Secondary Insurance Claims

Date: March 26, 2024 Attention: STAR Kids Providers/Consumer Directed Services employers and FMSA Providers Call to action: Texas Children’s Health Plan (TCHP) would like to share updates to the process of billing secondary insurance for program providers and financial management services agencies (FMSAs). With the implementation of EVV for the Home Health Care Services on January 1, 2024, concerns were brought forward regarding the billing EVV services as secondary insurance claims. Specifically, it was shared that a reason for denial is needed from...

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Provider Alert!
26Mar

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...

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