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15Mar

Provider Alert! TCHP Psychotropic Medication Utilization Review (PMUR

Date: March 14, 2023 Attention: Pediatricians, Psychiatrists Call to action: Texas Children’s Health Plan (TCHP) utilizes a PMUR program to promote safe prescribing of behavioral health medications to children and adolescents. TCHP identifies potential “prescribing outliers” using parameters established by the Texas Health and Human Services (HHSC). This does not mean the prescribing is wrong or harmful to the child, but requires additional review due to potential for adverse reactions, polyprescribing, and other implications. Who is identified for review? Members under the age of...

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14Feb

Provider Alert! COVID-19 UPDATE ALERT #4 – Telemedicine Services – Physicians, BH, FQHC and RHC Providers

Date: February 10, 2023 Attention: All providers  Effective Date: January 30, 2023 The content in this message on Federally Qualified Health Centers (FQHC) reimbursement for Telemedicine (Physician Delivered) and Telehealth (Non-Physician Delivered) Services as a distant site provider as permanent policy change (per S.B. 670, Texas Legislature, Regular session 2019) ended November 30, 2020 as announced by the Health and Human Services Commission. The content in this message on Rural Health Clinics as telehealth and telemedicine sites will remain in effect through March...

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Provider Alert!
13Jul

Provider Alert! Removal of Specialist Requirements from CAD Clinical Policies and Prior Authorization Criteria

Date: July 13, 2022 Attention: Providers Effective Date: August 1, 2022 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event. Call to action: HHSC is updating the prior authorization criteria for some clinician administered drugs. How this impacts providers: HHSC will no longer require the prescription include consultation with or be...

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12Jul

Provider Alert! Pediatric Updates for Moderna & Pfizer-BioNTech COVID-19 Vaccines

Date: July 12, 2022 Attention: All Providers Effective Date: June 17, 2022 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated with the COVID-19 event. TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event. Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that on June 17, 2022, the U.S. Food and Drug Administration (FDA) authorized emergency use of...

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Provider Alert!
30Jun

Provider Alert! Prior Authorization Criteria Update for Rinvoq and Cibinqo

Date: June 28, 2022 Attention: All Providers Effective Date: August 31, 2022 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event. TCHP will apply updates and reprocess impacted claims as soon as possible. However, please allow up to sixty (60) business days for reprocessing. Providers are not required to appeal...

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08Jun

Provider Alert! Age Range Updates for Drug Procedure Codes Effective April 1

Date: June 8, 2022 Attention: All Providers Effective date: April 1, 2022 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated with the COVID-19 event. TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event. Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that on April 1, 2022, the Health and Human Services Commission (HHSC) updated age ranges for...

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06May

Provider Alert! COVID-19 Pediatric Provider Enrollment

  Date: May 7, 2021 Attention: All Pediatric Providers Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event. Call to action: Texas Children’s Health Plan would like to inform network providers that the Texas Department of State Health Services (DSHS) Immunization Unit is encouraging all pediatric providers to enroll in...

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Provider Alert!
08Dec

Provider Alert! Annual Utilization Management Notice to All Providers

Attention: All Providers Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event.  Affirmative Statement about Incentives As a reminder, Texas Children’s Health Plan (TCHP) Utilization Management (UM) decision-making is based on our Policies, Procedures, and Guidelines. They are based only on appropriateness of care and service and the existence...

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Provider Alert!
11Sep

Provider Alert! Guidance for Laxatives for Medicaid Members

Attention: All Providers Effective Date: September 3, 2020 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event. Call to action: Polyethylene Glycol [PEG] 3350 (generic for Miralax), ClearLax (powdered formulation of PEG 3350) and generic lactulose are all laxatives on the Texas Medicaid drug formulary. These agents are...

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Provider Alert!
10Jun

Provider Alert! Continuing Medical Education/Ethics: Neonatal Abstinence Syndrome Awareness Month resources and events online

Attention: All Obstetric Care Providers Effective Date: June 4, 2020 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event. Call to action: In recognition of Neonatal Abstinence Syndrome (NAS) Awareness Month for the month of June, Texas Children’s Health plan (TCHP) would like to inform you of resources and...

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