Specialists

Articles with relevant information for Specialists.

Provider Alert!
27Feb

Provider Alert! Coverage of Elevidys Begins January 2024

Date: February 27, 2024 Attention: All Providers Prior authorization effective date: February 1, 2024 Call to action: The purpose of this communication is to inform providers that on January 1, 2024, Elevidys became a benefit of Medicaid and CHIP. Texas Health and Human Services Commission (HHSC) requires prior authorization for Elevidys (procedure code J1413) for Medicaid and CHIP, effective February 1, 2024. Elevidys is an adeno-associated virus vector-based gene therapy indicated for the treatment of ambulatory pediatric clients ages 4 through 5 years with...

By Facilities, OB/GYNs, Office Managers, Pharmacy, Primary Care Providers, Provider Alert, Specialists, , , 0 CommentsRead more...
Provider Alert!
26Feb

Provider Alert! HCPCS and CPT Code Prior authorization Update

Date: February 26, 2024 Attention: All Providers Effective date: January 1, 2024 Call to action: The purpose of this communication is to offer information about the Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) prior authorization updates. Resource: https://www.tmhp.com/sites/default/files/file-library/resources/rate-and-code-updates/hcpcs-updates/2024-hcpcs-special-bulletin.pdf How this impacts providers: Effective January 1, 2024 Texas Children’s Health Plan’s (TCHP's) prior authorization updates are listed below. These changes follow guidance from Texas Medicaid and Healthcare Partnership (TMHP). Medical necessity criteria for utilization review will be in accordance with Texas Medicaid...

By HHSC, OB/GYNs, Office Managers, Pharmacy, Primary Care Providers, Provider Alert, Specialists, , 0 CommentsRead more...
Provider Alert!
26Feb

Provider Alert! Enzyme Replacement Therapy Prior Authorization Update

Date: February 26, 2024 Attention: All Providers Effective date: February 1, 2024 Call to action: Texas Children’s Health Plan would like to make providers aware of prior authorization updates for certain enzyme replacement therapies. In alignment with Texas Medicaid Provider Procedure Manual (TMPPM) requirements, effective for dates of service on or after February 1, 2024, prior authorization will be required for enzyme replacement therapy velmanse alfa-tycv (Lamzede), procedure code J0217, and pegunigalsidase alfa-iwxj (Elfabrio), procedure code J2508. Prior Authorization Requirements include the following: Velmanse alfa-tycv...

By OB/GYNs, Office Managers, Pharmacy, Primary Care Providers, Provider Alert, Specialists, 0 CommentsRead more...
Provider Alert!
26Feb

Provider Alert! Optum’s Change Healthcare Network Interruption Update: Payment Information

Attention: All Providers Date: February 26, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to provide an update regarding Optum’s recent Change Healthcare network interruption. In an effort to mitigate the financial impact to our providers, TCHP has activated an alternative payment process that will be in effect until Optum’s Change Healthcare process is restored.   Alternative payment information  Payments for claims received will be made via check until electronic funds transfer (EFT) is setup with our Accounts Payable department (please see...

By OB/GYNs, Office Managers, Pharmacy, Primary Care Providers, Provider Alert, Specialists, , , 0 CommentsRead more...
Provider Alert!
22Feb

Provider Alert! UPDATED Medicaid Re-enrollment Application Assistance is Available

Date: February 22, 2024 Attention: All Providers Call to action: Texas Children's Health Plan (TCHP) would like to remind providers that continued assistance is available to their patients who need help with their Medicaid Reenrollment Application. Providers should encourage patients with Texas Children’s Health Plan coverage to contact us for assistance and support. How can you help ensure your patients stay covered?  Your continued assistance is crucial to helping your patients maintain coverage so they can access health care. Please ask your patients to:  Make...

By OB/GYNs, Office Managers, Pharmacy, Primary Care Providers, Provider Alert, Specialists, , , 0 CommentsRead more...
Provider Alert!
22Feb

Provider Alert! Important: Change Healthcare Network Interruption

Date: February 22, 2024Attention: All Providers Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers of some recent information we have received from our clearinghouse, Change Healthcare.   Change Healthcare is experiencing a network interruption related to a cyber-security issue and are working to address the matter. Once they became aware of the infiltration, they took immediate action to disconnect their systems to prevent further impact. At this time, they do not have an estimation of when the system...

By OB/GYNs, Office Managers, Pharmacy, Primary Care Providers, Provider Alert, Specialists, , 0 CommentsRead more...
Provider Alert!
21Feb

Provider Alert! EVV Program Providers and FMSAs: Register for HHAeXchange Webinar Friday, February 23

Date: February 20, 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 providers know that program providers, financial management services agencies (FMSAs) and Consumer Direct Services (CDS) EVV Program Providers and FMSAs: Register for HHAeXchange Webinar Friday, February 23, 2024. HHAeXchange is hosting a Provider Forum: Navigating HHAeXchange webinar on February 23, for EVV program providers and financial management services agencies (FMSAs) who use HHAeXchange as their EVV system. The webinar...

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Provider Alert!
16Feb

Provider Alert! Update to Clarify Delivery of Certain Behavioral Health Services through Synchronous Audiovisual or Synchronous Telephone (Audio-Only) Technology

Date: February 16, 2024 Attention: Behavioral Health Providers Effective date: December 1, 2023 Call to action: The purpose of this communication is to provide further information about the October 26 Provider Alert.  This alert provides updates to some of the behavioral health Medicaid benefits and to clarify the delivery of those services through synchronous audiovisual or synchronous telephone (audio-only) technology that are effective December 1, 2023. Texas Children’s Health Plan (TCHP) follows the limitations and requirements for the corresponding behavioral health codes outlined by...

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Provider Alert!
16Feb

Provider Alert! Generic for Rapumune Tablets and Solutions (Sirolimus) Now Preferred

Date: February 16, 2024 Attention: All Providers Effective: February 12, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective February 12, 2024, sirolimus tablets and generics will now be preferred. This is in response to the discontinuation of the brand product Rapamune 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 medication for their...

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Provider Alert!
16Feb

Provider Alert! Reminder: Prior Authorization Form Completion

Date: February 13, 2024 Attention: All Providers Call to action: Texas Children’s Health Plan (TCHP) supports the guidance from Texas Health and Human Services Commission (HHSC) on rejecting the Prior Authorization (PA) received with incomplete or insufficient documentation per Uniform Managed Care Manual (UMCM), Chapter 3.22. ‘Essential Information’ is the information required to initiate the PA review process, and are as follows: Member name Member number or Medicaid number Member date of birth Requesting provider name Requesting provider’s National Provider Identifier (NPI) Service requested – Current Procedural Terminology (CPT),...

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