Tag - DME

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...

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Provider Alert!
28Apr

Provider Alert! New Audit Programs Vendor EXL

Date: April 27, 2023 Attention: All Providers Effective Date: April 26, 2023 Call to action: Texas Children’s Health Plan (TCHP) Controls and Compliance (CC) would like to let providers know that TCHP has contracted with an external auditor, ExlService.com (EXL) to support its upcoming audit efforts. For your awareness, TCHP’s CC is organized within the Office of General Counsel under the Controls and Compliance Department. EXL is currently conducting audits, and will introduce the following new audit programs starting April 26, 2023: High Cost Drug...

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Provider Alert!
25Jan

Provider Alert! Signature Requirement Reinstated on DME Forms

Date: January 19, 2022 Attention: DME Providers Effective Date: January 1, 2022 TCHP COVID-19 Utilization Management Procedure and TCHP provider alerts can be found here: http://www.thecheckup.org/provider-alerts/ TCHP network providers should monitor the 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: Effective January 1, 2022, a member or member’s authorized representative’s signature is required on DME Certification and...

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Provider Alert!
09Nov

Provider Alert! Update to the Durable Medical Equipment and Supplies Handbook

Date: November 4, 2021 Attention: Durable Medical Equipment, Primary Care, and Gastroenterologist Providers 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: On November 1, 2021, Texas Medicaid Health Partnership (TMHP) will update the Texas Medicaid Provider Procedures Manual, Durable Medical Equipment...

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Provider Alert!
27Jul

Provider Alert! Prior authorization Updates   

Date: July 23, 2021 Attention: All Providers Effective Dates: August 1, 2021 and 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: Services no longer requiring a prior authorization effective August 1, 2021 include the following: Biofeedback Codes 90901, 90912, and 90913 Durable Medical Equipment (DME)...

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Provider Alert!
10Sep

Provider Alert! Irreparably Damaged DME Prosthetics, Orthotics, & Supplies during Hurricane Laura

Attention: DME Providers Date: September 9, 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) aligns with the guidance from Health & Human Services Commission (HHSC) regarding replacement of durable medical equipment (DME) supplies that may have been destroyed or lost...

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Provider Alert!
24Jun

Provider Alert! Benralizumab, Mepolizumab, and Omalizumab Benefits in the Home Setting

Attention: Pulmonologists, Allergists, and DME Providers Effective Date: For dates of service on or after 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) aligns with the new guidelines from the Health and Human Services Commission (HHSC) for dates of...

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Provider Alert!
18Jun

Provider Alert! Home Health DME and Supplies Exceptional Circumstances Provision for Medicaid Members 21 years of age and older

Attention: DME Providers Effectvie 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 aligns with the Texas Medicaid and Healthcare Partnership (TMHP) new guidance for Durable Medical equipment (DME) and supplies under exceptional circumstances. Effective June 1, 2020...

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Provider Alert!
01Oct

Provider Alert! DME/equipment/supplies exceeding Texas Medicaid Limitations

Effective October 1, 2019, Texas Children’s Health Plan will implement a prior authorization process for providers to request prior approval to provide DME/Equipment/Supplies to members 20 years of age and under in excess of benefit limitations. Texas Children’s Health Plan applies benefit limitations for DME/Equipment/Supplies in accordance with the Texas Medicaid Provider Procedure Manual (TMPPM) for all members eligible to receive the benefit, except for the following:   Next steps for providers: DME/Equipment/Supplies for a member who is 20 years of age or younger...

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Provider Alert!
15May

Provider Alert! DME/Supplies Exceeding Medicaid Limitations

Texas Children’s Health Plan applies benefit limitations for DME Supplies and Equipment per the current TMHP Manual for all members eligible to receive the benefit. See benefit exceptions below. Frequency of Billing As a reminder, DME monthly limits will be applied every 27 days. Claims for recurring DME rentals and/or monthly disposable supplies billed prior to this renewal date are subject to denial.  Denied claims may be appealed through the standard appeal process with supporting documentation to establish and/or support medical necessity. What...

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