hhsc – The Checkup

21DecDecember 21, 2023

Provider Alert! Health and Human Services (HHSC) Launched Direct Care Careers Online Portal

Date: December 21, 2023 Attention: Personal Care Attendant, Community Attendant, Direct Care Staff Call to action: Texas Children’s Health Plan (TCHP would like to share an announcement from HHSC: HHSC is happy to announce the launch of Direct Care Careers, an optional, online portal that will connect potential employees with employers delivering home and community-based services through the state plan and HCBS authorities (1915(c), 1915(i), 1915(j), and 1115). Direct Care Careers Description: Direct Care Careers is an optional, online platform to connect employers with...

By Texas Children's Health PlanOffice Managers, Provider AlertCareers, Direct Care, HCBS, hhsc, Portal0 CommentsRead more...

25SepSeptember 25, 2023

Provider Alert! HHSC Does Not Cover Vaccines or Drugs That Do Not Have FDA Approval or Emergency Use Authorization

Date: September 25, 2023 Attention: All Providers Effective date: August 31, 2023 Call to action: The purpose of this communication is to inform providers that Texas Medicaid and CHIP do not cover vaccines or drugs that are not authorized or approved by the U.S. Food and Drug Administration (FDA). Health and Human Services Commission (HHSC) will not cover procedure codes related to COVID-19 vaccine or drugs administration as non-risk payments (NRP) if the COVID-19 vaccines or drugs no longer have FDA approval or authorization....

By Texas Children's Health PlanUncategorizedCOVID, COVID-19, fda authorization, hhsc, non-approved, vaccines0 CommentsRead more...

01JunJune 1, 2023

Provider Alert! HHSC to Implement Gattex® Clinical Prior Authorization on June 6, 2023

Date: May 31, 2023 Attention: All Providers Effective Date: June 6, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective June 6, 2023, Texas Health and Human Services (HHSC) will be implementing the Gattex® clinical prior authorization criteria, which was approved on April 28, 2023. How this impacts providers: Starting June 6, 2023, TCHP will implement the Gattex® clinical prior authorization criteria. The new criteria is available on the HHSC Vendor Drug Program website and can...

By Texas Children's Health PlanOB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialistsclinical prior authorization, Gattex, hhsc, VDP0 CommentsRead more...

04MayMay 4, 2023

Provider Alert! Quantity Limit Change for Direct Antivirals Scheduled for May 25, 2023

Date: May 4, 2023 Attention: All Providers Effective Date: May 25, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective May 25, 2023, the Health and Human Services Commission (HHSC) is implementing new policies to improve access and adherence to direct antivirals. Providers will now be able to write prescriptions for the entire course of therapy for the direct antivirals, eliminating the need for additional refills. How this impacts providers: Starting May 25, 2023, due to...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialistsantiviral, hhsc, Mavyret, METAVIR0 CommentsRead more...

13SepSeptember 13, 2022

Provider Alert! RSV Summer Season Changes Begin September 1

Date: September 13, 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) would like to inform providers that the Health and Human Services Commission (HHSC) will close the 2022 Respiratory Syncytial Virus...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialistshhsc, Respiratory Syncytial Virus, RSV, VDP0 CommentsRead more...

13SepSeptember 13, 2022

Provider Alert! Hepatitis C Treatment Coverage and PDL Update Delayed to Jan. 1, 2023

Date: September 12, 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) would like to inform providers that on January 1, 2023 Texas Medicaid will designate one medication as the primary preferred...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialistsanti-venom, DAA, Hep C, Hepatitis C, hhsc, METAVIR0 CommentsRead more...

06AprApril 6, 2022

Provider Alert! Age and Diagnosis Restriction Updates for Drug Procedure Codes, Effective March 1

Date: April 6, 2022 Attention: Providers Effective Date: March 1, 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: On March 1, 2022, HHSC updated age and diagnosis restrictions for drug procedure codes J0596, J0598, J0599, and J9348 for Medicaid and CHIP. Fee-for-service criteria for J0596,...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialistsage restriction, diagnosis restriction, drug procedure codes, hhsc, Procedure Codes0 CommentsRead more...

06AprApril 6, 2022

Provider Alert! External Medical Review Provider Training now available

Date: April 5, 2022 Attention: All Providers Effective date: February 28, 2022 Call to action: TCHP would like to inform providers of training on External Medical Review (EMR) available from the Health and Human Services Commission. The purpose of this training is to provide an overview to providers on the role/responsibilities for participants involved in an EMR following receipt of an Adverse Benefit Determination from a MCO or dental contractor. TCHP follows the guidance on (EMR) in accordance with the Uniform Managed Care...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialistsemr, external medical review, hhsc, iro, provider training0 CommentsRead more...

04AprApril 4, 2022

Provider Alert! Provider enrollment revalidation extension has ended

Date: March 29, 2022 Attention: All providers Effective Date: March 29, 2022 The extension for revalidation due dates for currently enrolled providers ended on February 28, 2022 as announced by the Health and Human Services Commission (HHSC). TCHP COVID-19 Utilization Management Procedure and provider alerts can be found here: http://www.thecheckup.org/provider-alerts/ 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...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialistshhsc, medicaid, PEMS, Provider Enrollment, revalidation, texas, tmhp0 CommentsRead more...

28JanJanuary 28, 2022

Provider Alert! Removal of Specialist Requirement from Clinical Prior Authorization Criteria

Date: January 28, 2022 Attention: Providers Effective Date: January 3, 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: Effective January 3, 2022, HHSC removed the specialist requirement from the following clinical prior authorization criteria: CGRP Antagonist, Acute CGRP Antagonists, Chronic Emflaza Ophthalmic Immunomodulators Palforzia Transthyretin Agents VMAT2 Inhibitors Wakix Xyrem/Xywav Zelboraf How this impacts providers: Providers...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialistsclinical prior authorization, hhsc, Prior Authorization, specialist requirement0 CommentsRead more...

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