Tag - Diagnosis Codes

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...

By HHSC, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialists, , 0 CommentsRead more...
Provider Alert!
03Nov

Provider Alert! T1000 Guidance with UA Modifier

Date: November 3, 2022 Attention: Private Duty Nursing 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 provide guidance on the billing requirements for T1000 with the UA modifier, as outlined in the Home Health Nursing...

By Provider Alert, Specialists, , , 0 CommentsRead more...
20May

Provider Alert! New COVID 19 Diagnosis Codes and Inpatient ICD-10-PCS Procedure Codes

Date: May 17, 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. 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...

By Facilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialists, , 0 CommentsRead more...
Provider Alert!
12Apr

Provider Alert! Benefit Criteria for Evoked Response Tests and Neuromuscular Procedures Update

Date: April 7, 2022 Attention: Neurologists Effective date: March 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. 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...

By Provider Alert, Specialists, , , 0 CommentsRead more...
Provider Alert!
08Dec

Provider Alert! Yescarta Prior Authorization Criteria Update

Date: December 7, 2021 Attention: Oncologists Effective Date: November 1, 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 updated the clinical prior authorization criteria for Yescarta (procedure code Q2041) to align with the recent FDA indication expansion and guidance from the...

By Provider Alert, Specialists, , , 0 CommentsRead more...
Provider Alert!
17Jun

Provider Alert! Additional Diagnosis Codes and Place of Service Added for Ravulizumab-cwvz (Ultomiris)

Attention: Hematologists, Gastroenterologists, Rheumatologists Effective Date: June, 1 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: Texas Children’s Health Plan (TCHP) would like to inform you that we align with Texas Medicaid Provider Procedure Manual (TMPPM) regarding the guidelines for ravulizumab-cwvz, (Ultomiris), procedure code J1303....

By Provider Alert, Specialists, 0 CommentsRead more...