Specialists

Articles with relevant information for Specialists.

27Sep

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. Provider type level/type of care appointment availability standards OB/GYN ·       Emergency services   ·       Urgent condition   ·       Prenatal care for initial appointments   ·       Prenatal care...

By OB/GYNs, Primary Care Providers, Provider Alert, Specialists, 0 CommentsRead more...
Provider Alert!
11Sep

Provider Alert! Benefit Changes Prior Authorization Update

Attention: All Texas Children’s Health Plan Providers Subject: UPDATE to Changes for Physical, Occupational, and Speech Therapy Benefits   Prior Authorization Changes Update Changes to TCHP Prior Authorizations for PT, OT, and ST services: For therapy authorizations with approved dates of service spanning the 9/1 transition date, TCHP created a revised authorization in our system that reflects the new billing structure using the same authorization number. For all therapy requests that were submitted prior to 9/1, the revised authorization will start on 9/1 and cover through the end of...

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05Sep

HHSC Hurricane Harvey Information for Providers

HHSC has created new resources for Providers to remain informed about Hurricane Harvey: Hurricane Harvey Medicaid and Children’s Health Insurance Program (CHIP) - Frequently Asked Questions Hurricane Harvey Information for Providers Website - Click here

By HHSC, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialists, 0 CommentsRead more...
20Aug

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.   Provider Type Level/Type of Care Appointment Accessibility Standards OB/GYN Low Risk Pregnancies Provided within 14 calendar days High Risk Pregnancies Offered within 5 calendar...

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11Aug

Enhance your adolescent care with SBIRT

It’s back-to-school season, a time when pediatrics offices are busy with well-child checks and sports physicals. Pediatricians are in an excellent position to educate adolescents about their health, including providing guidance about substance use. The AAP advises on universal substance use screening using SBIRT techniques for all adolescents. In lower-risk patients, they can prevent or delay the onset of use. For intermediate-risk patients, they can discourage ongoing use and reduce harm. And they can refer patients who have developed substance...

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25Jul

Updated STAR Kids billing matrix effective June 5, 2017.

Updated STAR Kids billing matrix effective June 5, 2017. Updates include: Registered nurse modifier (TD) to the private duty nursing (PDN) billing code, T1000 Billing codes for PDN independently enrolled LVNs and RNs are included in the matrix Revenue code 663 was added to the out-of-home respite codes. Please note that failure to use this billing matrix will result in denials for incorrectly billed services. For more information on this topic, visit http://www.texaschildrenshealthplan.org/for-providers .

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18Jul

Prior Authorization of Texas Health Steps (THSteps) dental therapy under general anesthesia for members who are six years of age or younger

Effective July 1, 2017, Texas Children’s Health Plan will be required to implement prior authorization for Level 4 deep sedation and general anesthesia provided in conjunction with therapeutic dental treatment for Medicaid dental clients from ages 0 through six years. All Level 4 services must be authorized prior to rendering services. Anesthesia services provided by a dentist should use procedure code D9223. Any anesthesia services provided by an anesthesiologist (M.D./D.O.) or certified registered nurse anesthetist (CRNA), should use procedure code 00170,...

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