Tag - CHIP

Provider Alert!
18Mar

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...

By OB/GYNs, Office Managers, Pharmacy, Primary Care Providers, Provider Alert, Specialists, , , 0 CommentsRead more...
Provider Alert!
13Feb

Provider Alert! 12-Month Postpartum Eligibility Extension for Medicaid and CHIP Pregnant Members

Date: February 13, 2024 Attention: Primary Care, Family Medicine, and Obstetric Care Providers Effective: March 1, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to share great news with providers about postpartum Medicaid coverage. The Texas Health and Human Services Commission (HHSC) extended postpartum Medicaid coverage from two to 12 months for eligible women, effective March 1, 2024, as part of House Bill 12 (H.B. 12), 88th Legislature, Regular Session, 2023. Also effective March 1, 2024, HHSC will be providing 12...

By OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialists, , 0 CommentsRead more...
Provider Alert!
08Nov

Provider Alert! COVID-19 Vaccine and Vaccine Administration Procedure Codes 91318, 91319, 91320, 91321, 91322, and 90480 Are Now Benefits of Medicaid and CHIP

Date: November 7, 2023 Attention: All Providers Effective for dates of service on or after September 11, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that in accordance with the U.S. Food and Drug Administration’s amended Emergency Use Authorizations COVID-19 vaccine administration codes for the Pfizer-BioNTech and Moderna COVID-19 vaccines, vaccine procedure codes 91318, 91319, 91320, 91321, 91322, and vaccine administration procedure code 90480 are benefits for Medicaid and CHIP. How this impacts providers: The procedure codes are...

By OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialists, , , 0 CommentsRead more...
Provider Alert!
28Aug

Provider Alert! HHSC to Add Skysona® as Medicaid and CHIP Benefit July 1, 2023, Prior Authorization Effective September 1, 2023

Date: August 24, 2023 Attention: All Providers Effective Date: September 1, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective September 1, 2023, the Texas Health and Human Services (HHSC) will be implementing required prior authorization criteria for Skysona® (procedure code J3590) for Medicaid and CHIP. Skysona® will become a benefit of Medicaid and CHIP on July 1, 2023. Skysona® (betibeglogene autotemcel) is indicated to slow the progression of neurologic dysfunction in boys 4-17 years...

By OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialists, , , , , 0 CommentsRead more...
Provider Alert!
23Aug

Provider Alert! CHIP $20,000 CAP for Durable Medical Equipment (DME), Prosthetic Devices and Disposable Medical Supplies Now Active

Date: August 22, 2023 Attention: CHIP Providers Effective date: May 23, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that in accordance with the Uniform Managed Care Manual, for CHIP Members, there is a $20,000 12-month period limit for DME, prosthetics, devices and disposable medical supplies limitation (diabetic supplies and equipment are not counted against this cap). Covered services require prior authorization and physician prescription when in excess of benefit limitations for members 20 years of age...

By OB/GYNs, Primary Care Providers, Provider Alert, Specialists, , 0 CommentsRead more...
Provider Alert!
19Jul

Provider Alert! Zynteglo® now a Medicaid and CHIP Benefit – Prior Authorization Effective September 1, 2023

Date: July 18, 2023 Attention: All Providers Effective Date: September 1, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective September 1, 2023, the Texas Health and Human Services (HHSC) will be implementing required prior authorization criteria for Zynteglo® (procedure code J3590) for Medicaid and CHIP. Zynteglo® became a benefit of Medicaid and CHIP on July 1, 2023. Zynteglo® (betibeglogene autotemcel) is an autologous stem cell-based gene-therapy indicated for treating adult and pediatric patients with...

By Facilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialists, , , , 0 CommentsRead more...
Provider Alert!
13Jul

Provider Alert! No-cost sports and school physicals for CHIP and Medicaid patients

Date: July 13, 2023 Attention: Primary Care Providers, OB/GYNs, and Office Managers Call to action:  It will soon be back-to-school season, which means your patients will need to complete their annual sports and school physicals. As part of the Healthy Rewards Program*, Texas Children’s’ Health Plan CHIP, STAR and STAR Kids members ages 5 to 19 years** can receive a no-cost sports and school physical. A Texas Health Steps or well-child visit within the last 12 months is required. Members should bring...

By OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, , 0 CommentsRead more...
21Mar

Provider Alert! Reinstatement of CHIP Co-pays for Medical Office Visits

Date: March 20, 2023 Attention: All Providers Effective Date: May 12, 2023 Call to action: In response to the COVID-19 public health emergency (PHE), the Health and Human Services Commission (HHSC) waived co-pays for Children’s Health Insurance Program (CHIP) medical office visits beginning March 13, 2020. HHSC will reinstate co-pays for CHIP medical office visits on May 12, 2023, because the federal PHE ends on May 11, 2023. The reinstatement of medical office visit co-pays does not apply to: COVID-19-related office visits for COVID-19...

By OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialists, , , , , 0 CommentsRead more...
Provider Alert!
13Dec

Provider Alert! CHIP Coverage of Monkeypox Testing and Vaccines

Date: December 13, 2022 Attention: All Providers Effective date: Dates of service on or after July 26, 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: Texas Children’s Health Plan (TCHP) would like to inform providers that Monkeypox testing and vaccines are a covered benefit in...

By OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialists, , , 0 CommentsRead more...
Provider Alert!
13Sep

Provider Alert! Healthy Rewards/Value Added Services for 2022-2023

Date: September 1, 2022 Attention: All Providers Effective Date: September 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) is proud to present our Healthy Rewards Program/Value Added Services (VAS) program effective September 1, 2022 through August 31, 2023....

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