Tag - Navitus
26Oct

Provider Alerts! Cosentyx Clinical Prior Authorization Criteria Revision Scheduled for November 22

Date: October 25, 2022 Attention: Providers Effective Date: October 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: Texas Children Health Plan (TCHP) will revise clinical prior authorization criteria for Cosentyx to comply with the recent Food and Drug Administration-approved age indications. How this impacts providers:...

By Facilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialists, , , , , 0 CommentsRead more...
Provider Alert!
08Apr

Provider Alert! Changes to Hepatitis C Prior Authorization Criteria

Date: July 14, 2021 Attention: Primary Care Providers Effective Date: September 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: Effective September 1, 2021, Medicaid will expand coverage of the Hepatitis C virus clinical prior authorization criteria to include all metavir fibrosis scores. How this impacts...

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

Upcoming Changes to Prior Authorization for Antipsychotic Medications

Effective September 1, 2018, the prior authorization for antipsychotic medications will change. At the May 15th Texas Association of Community Health Plans P&T Committee meeting, the Texas Managed Care Organizations, supported by Navitus, voted by majority to modify the Antipsychotic Clinical Prior Authorization Edit in compliance with the guidelines set forth by the Health and Human Services Commission Vendor Drug Program. The health plans opted to remove the requirements for diagnoses, while maintaining criteria for age and duplicate therapy in...

By OB/GYNs, Office Managers, Primary Care Providers, Specialists, , , 0 CommentsRead more...
26Mar

5 steps to a Successful Authorization

Know what requires a prior authorization. Go to TexasChildrensHealthPlan.org or Navitus.com to check prior authorization requirements for Medical/Behavioral Health services before providing services or sending prescriptions to the pharmacy. Become familiar with the authorization guidelines. Guidelines are available upon request and on the Texas Children’s Health Plan Provider TouCHPoint portal at TexasChildrensHealthPlan.org/for-providers. Submit requests in advance of the scheduled service. Authorizations for outpatient services can take 3 business days to process. Ensuring that submissions are done in advance will avoid potential claim denials. Be comprehensive in...

By Office Managers, , , 0 CommentsRead more...
12Mar

Attention: Star Kids Providers: Prior Authorization required on all Vendor Drug Program (VDP) identified medications

Texas Children’s Health Plan requires prior authorization (PA) on all medications on the VDP website prior to dispensing to members. To obtain a list of medications requiring prior authorization, visit the VDP website at: http://www.txvendordrug.com/formulary/preferred-drugs.shtml Providers can also view instructions on accessing and using the formulary at the Texas Children’s Health Plan website: http://www.thecheckup.org/2016/06/09/do-you-know-how-to-access-the-texas-childrens-health-plan-formulary/ Providers can submit PA documentation to Texas Children’s Health Plan’s pharmacy benefit manager, Navitus. PA forms can be found here: https://www.navitus.com/texas-medicaid-star-chip/prior-authorization-forms.aspx Prior authorizations need to be submitted to Navitus by faxing to...

By Primary Care Providers, Provider Alert, Specialists, , , , 0 CommentsRead more...
Provider Alert!
02Feb

Provider Alert! Prior Authorization required on all Vendor Drug Program (VDP) identified medications

Attention: Star Kids Providers Subject: Reminder: Prior Authorization required on all Vendor Drug Program (VDP) identified medications Texas Children’s Health Plan requires prior authorization (PA) on certain medications per the VDP website prior to dispensing to members. To obtain a list of medications requiring prior authorization, visit the VDP website at: http://www.txvendordrug.com/formulary/preferred-drugs.shtml Providers can also view instructions on accessing and using the formulary at the Texas Children’s Health Plan website: http://www.thecheckup.org/2016/06/09/do-you-know-how-to-access-the-texas-childrens-healthplan-formulary/ Providers can submit PA documentation to Texas Children’s Health Plan’s pharmacy benefit manager, Navitus....

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