Tag - Coding

Provider Alert!
20Jun

Provider Alert! Prior Authorization Diagnosis Coding Reminder

Date: June 20, 2023 Attention: All Providers Call to action: As a reminder, Texas Children’s Health Plan (TCHP) aligns with the Texas Medicaid Provider Procedure Manual (TMPPM) regarding the ICD-10-CM diagnosis-coding requirement on claim submissions. Resource: TMPPM Section 6: Claims filing How this impacts providers: Diagnosis codes guidance as outlined in the TMPPM are as follows: Diagnosis codes must be to the highest level of specificity available Diagnosis codes must be appropriate for the age of the client as identified in the ICD-10-CM description of the...

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Provider Alert!
06Jun

Provider Alert! Screening and Coding for Social Determinants of Health – Introducing Texas Children’s Family Resources

Date: June 5, 2023 Attention: Primary Care and Obstetric Care Providers Call to action: Are your patients struggling to meet their basic needs? Connect them today with Texas Children’s Family Resources to find food and housing assistance, help paying bills, and other free or reduced-cost programs. https://txchfamilyresources.org/ As stewards of our member’s care, Texas Children’s Health Plan (TCHP) would like to remind you of social determinants of health.  Social determinants of health (SDOH) are non-clinical societal and environmental conditions such as lack of access to...

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Provider Alert!
18Feb

Provider Alert! CPT Coding for Self-Measured Blood Pressure Monitoring

Date: February 18, 2021 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. Call to action: Texas Children’s Health Plan would like to inform network providers of Current Procedural Terminology (CPT®) Codes available to support self-measured blood pressure monitoring. How this impacts providers: The CPT Codes include...

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Provider Alert!
14Sep

Provider Alert! Screening and Coding for Social Determinants of Health – Introducing Texas Children’s Family Resources

Attention: Primary Care and Obstetric Care 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: Are your patients struggling to meet their basic needs? Connect them today with Texas Children’s Family Resources to find food and housing assistance, help paying bills, and other free or reduced-cost...

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Provider Alert!
27Jul

Provider Alert! Second Quarter 2020 HCPCS Updates for Texas Medicaid

Attention: All Providers Effective Date: July 1, 2020 Updated September 10, 2020 Call to action: Texas Children’s Health Plan (TCHP) aligns with the Healthcare Common Procedure Coding System (HCPCS) additions, revisions, and discontinuations that are implemented for claims processing by TMHP for Texas Medicaid. How this impacts providers: Second Quarter 2020 HCPCS Added Procedure Codes are as follows: Clinician Administered Drug (CAD) Procedure Codes C9061 J0223 J0691* J0742 J0791* (replacing C9053) J0896  J7169* J7204 J9177 J9246 J9358 Q5119 Q5120     The follow codes have age restrictions: J1201 – 6 months and older J1558 – 2 years and older J0791 – 16...

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Provider Alert!
15Apr

Provider Alert! Second Quarter National Correct Coding Initiative updates

Call to action: Texas Children’s Health Plan (TCHP) supports the National Correct Coding Initiative (NCCI) updates that are implemented for claims processing by TMHP for Texas Medicaid. How this impacts providers: For Health and Behavior Assessment and Intervention (HBAI), codes 96170 and 96171 will no longer be reimbursed after April 1, 2020. Procedure codes 96167 and 96168 will be the only codes for HBAI, which include the member’s family,  that may be reimbursed when the family member directly participates in the...

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Provider Alert!
12Oct

Provider Alert! Texas Children’s Health Plan Claim Editing System Update

Attention:  All Providers Subject: Texas Children’s Health Plan Claim Editing System Update Effective: 12/27/2018   Texas Children’s Health Plan intends to transition to a new Claims Editing System (CES) by Optum on 12/27/2018. Please be aware that claims submitted prior to 12/27/2018 will continue to be processed by our current vendor, McKesson Claim Check. TCHP is required by Texas Health and Human Services to ensure all required claims edits are consistently applied. Migrating to Optum CES will enable TCHP to efficiently apply all required coding...

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17Jul

Provider Alert! Coding Changes to Postpartum Depression Screening

Maternal depression is a serious and prevalent condition that not only affects the mother, but may present a substantial early risk to appropriate child development, the mother-infant bond, and the family. According to the AAP, it has been estimated that 5 percent to 25 percent of all pregnant, postpartum, and parenting women have some type of depression. Mothers who have low incomes are more likely to experience some form of depression than the general population of mothers. A maternal depression...

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11Jul

Immediate postpartum long-acting reversible contraceptives (LARCs): claim processing procedure update

Long-acting reversible contraceptives (LARCs) are beneficial to subsequent maternal health outcomes as they enhance family planning and safer birth spacing. The Texas Medicaid Provider Procedures Manual was updated earlier this year to reflect new language related to immediate postpartum LARC device insertion. Language in subsection 2.2.5.4, “Immediate Postpartum Insertion of IUDs and Implantable Contraceptive Capsules” was updated regarding immediate postpartum LARC insertion and claim processing procedures. The new language states that procedure codes for LARCs may be reimbursed in addition to...

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01Feb

HEDIS Spotlight: Prenatal / Postpartum Care

HEDIS stands for Healthcare Effectiveness Data and Information Set. It is a widely used set of performance measures by the nation’s health plans, and an essential tool in ensuring that our members are getting the best healthcare possible. It is extremely important that our providers understand the HEDIS® specifications and guidelines. In this section of The Checkup we will highlight different HEDIS metrics. We will provide a description of the measures, the correct billing codes to support services rendered and...

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