Tag - diabetes

Provider Alert!
22Dec

Provider Alert! Diabetic Equipment and Supplies-Home Health Policy & Monitoring Update

Date: December 22, 2023 Attention: All Providers Effective date: February 1, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to make providers aware that the Diabetic Equipment and Supplies-Home Health Policy has been updated effective February 1, 2024, to address the following changes: Changes in continuous glucose monitoring (CGM) client eligibility Prior authorization Follow up visits after initiating CGM utilization Removing the requirement to provide the make and model of the CGM on the Home Health Services (Title XIX) DME/Medical Supplies Physician Order Form How...

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

Provider Alert! Clinical Criteria for Tzield® (procedure code J9381) effective August 1, 2023

Date: July 11, 2023 Attention: All Providers Effective Date: August 1, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective August 1, 2023, the Texas Health and Human Services (HHSC) will be implementing prior authorization criteria for Tzield ® (procedure code J9381). The approval duration will be for the 14-day treatment. Tzield is the first-in-class therapy indicated to delay the onset of Stage 3 Type 1 diabetes (T1D) in adults and pediatric patients 8 years...

By Facilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialists, , , 0 CommentsRead more...
Provider Alert!
20Apr

Provider Alert! Prior Authorization Update for Continuous Glucose Monitoring

Date: April 20, 2021 Attention: All Providers Effective Date: April 20, 2021 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 short-term continuous glucose monitoring service Procedure Codes 95250 and 95251 will require prior authorization effective...

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Provider Alert!
18Mar

Provider Alert! Diabetes Awareness and Wellness Network (DAWN) Center

Date: March 18, 2021 Attention: Primary Care Providers and Endocrinologists 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) is happy to announce that we have partnered with the Diabetes Awareness and Wellness Network (DAWN) Center to serve as a viable...

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15Sep

HEDIS Toolkit Offers Benefits to Providers

Members are cared for as HEDIS measures are met  Texas Children’s Health Plan developed a HEDIS Toolkit that contains helpful information regarding the measure requirements, standards and codes to use that are acceptable for HEDIS reporting. The new toolkit can be accessed here. This toolkit will serve as a reference form that can be used to code the type of appointments made and ensure that all of the HEDIS standards are met.  This will help providers maintain high quality care and meet...

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Provider Alert!
02Apr

Provider Alert! Therapeutic Continuous Glucose Monitors Become Benefit of Texas Medicaid

Attention: Primary Care Providers and Endocrinologists  Effective Date: April 1, 2020 Call to action: Texas Children’s Health Plan (TCHP) supports Texas Medicaid Health Partnership’s (TMHP) decision to include therapeutic continuous glucose monitors (CGM) as a benefit for Texas Medicaid recipients.  A therapeutic CGM device requires prior authorization and is used as a replacement for self-blood glucose monitoring (SBGM). Members who have Type I or Type II diabetes may be considered for therapeutic CGM. All of the following medical necessity criteria must be met. The...

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17Feb

Diabetes Gift Card Available to Adult Texas Children’s Health Plan Members

If you currently treat an adult Texas Children’s Health Plan member (18 years or older) with diabetes, they can receive up to 3 $20 gift cards upon completion of each of the following: Annual diabetic eye exam OR Biannual HbA1c blood test (every 6 months) OR Maintain an under 8 HbA1c blood result every 6 months

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