Prior Authorization – Page 12

07JulJuly 7, 2020

Provider Alert! Age Limitation Change for Antisense Oligonucleotides Benefits

Attention: Neurologists Effective Date: For dates of service on or after January 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 prior authorization criteria available in the most recent Texas Medicaid Provider Procedures Manual, Clinician Administered...

By Texas Children's Health PlanProvider Alert, Specialistsneurology, Prior Authorization, provider alert, provider alerts0 CommentsRead more...

24JunJune 24, 2020

Provider Alert! Prosthetics Codes Prior Authorization Requirements

Attention: Prosthetics, DME providers, orthopedists, podiatrists, PCPs Effective Date: June 3, 2020 Call to action: Texas Children’s Health Plan (TCHP) aligns with Texas Medicaid Provider Procedures Manual (TMPPM) and requires prior authorization for prosthetics procedures codes. How this impacts providers: Provider offices should utilize the Standard Prior Authorization Form for prosthetics. References: TCHP Prior Authorization Requirements TCHP Prosthetics Guidelines Next steps for providers: Providers should reference the prosthetic procedure codes according to TMPPM section 2.2.19.2 Prior Authorization and Documentation Requirements. If you have any questions, please email Provider Network...

By Texas Children's Health PlanPrimary Care Providers, Provider AlertPrior Authorization, Prosthetics Code Update, provider alert, provider alerts0 CommentsRead more...

24JunJune 24, 2020

Provider Alert! Prior Authorization guidelines for Manual Wheelchair Accessory Code E2227

Attention: All Providers Effective Date: June 23, 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 Texas Medicaid Provider Procedures Manual (TMPPM) regarding the authorization requirements for Code E2227, manual wheelchair accessory, and gear reduction drive wheel,...

By Texas Children's Health PlanOB/GYNs, Office Managers, Primary Care Providers, Provider Alert, SpecialistsGuidelines, Prior Authorization, provider alert, provider alerts, wheelchair0 CommentsRead more...

24JunJune 24, 2020

Provider Alert! Update: Prior Authorization Criteria for Brexanolone (Zulresso)

Attention: : Behavioral Health and Obstetric care providers Effective Date: July 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 of a new benefit for members and an update to the prior authorization criteria for brexanolone...

By Texas Children's Health PlanProvider Alert, SpecialistsBehavioral Health, Prior Authorization, provider alert, provider alerts0 CommentsRead more...

23JunJune 23, 2020

Provider Alert! Authorization update for orthoses devices and related services

Attention: DME providers, orthopedists, podiatrists, PCPs Effective Date: September 5, 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 providers of the authorization requirements for custom fitted orthoses devices. Certain prefabricated orthoses devices for acute injury...

By tcphPrimary Care Providers, Provider Alert, SpecialistsOrthoses, Prior Authorization, provider alert, provider alerts0 CommentsRead more...

10JunJune 10, 2020

Provider Alert! Update: Updates to Prior Authorization Requirements

Attention: All Providers Effective Date: June 4, 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: TCHP would like to inform you of recent updates to the prior authorization requirements and the effective dates. Updates include the following: Medical services now requiring prior authorizations: Therapeutic Continuous Glucose Monitors-...

By tcphOB/GYNs, Office Managers, Primary Care Providers, Provider Alert, SpecialistsPrior Authorization0 CommentsRead more...

28MayMay 28, 2020

Provider Alert! Adakveo Update

Attention: Hematologists Effective Date: May 26, 2020 Call to action: Adakveo, Injection, crizanlizumab - clinician administered drug HCPCS code C9053 is an at risk drug. Currently, there is no prior authorization required; however, beginning May 26, 2020 authorization guidelines will be in place. The required criteria to receive Adakveo include: HbSS (sickle cell) diagnosis Patients over the age of 16 years-old Patients that have experienced more than two vaso-occlusive crisis (VOC) events in the past 12-months How this impacts providers: Prescribers should adhere to the guidelines and acquire...

By Texas Children's Health PlanProvider Alerthematology, prescription, Prior Authorization, provider alert, provider alerts, sickle cell0 CommentsRead more...

27MayMay 27, 2020

Provider Alert! Secretion and Mucous Clearance Device Update on rental option

Date: December 17, 2021 Attention: Pulmonologists and DME providers Effective Date: June 1, 2020 for Intrapulmonary Percussive Ventilation (IPV) rental information Call to action: update for December 17, 2021: Intrapulmonary Percussive Ventilation (IPV)*: effective June 1, 2020, this device is available for rent only and no longer has the rent to purchase option. Secretion and mucous clearance devices will require prior authorization except for percussion cups. Here is the link to the Prior Authorization Form: https://www.tmhp.com/sites/default/files/provider-forms/pa-forms/F00145_Prior_Auth_for_Secretion_and_Mucus_Clearance_Devices_Initial.pdf Information on coding for devices: Device Code Intrapulmonary Percussive Ventilation (IPV)* E0481. TCHP...

By Texas Children's Health PlanProvider Alert, SpecialistsMucous Clearance Device, Prior Authorization, provider alert, provider alerts, Secretion0 CommentsRead more...

07AprApril 7, 2020

Provider Alert! COVID-19 Disaster Declaration – ALERT #3 – Prior Authorization Adjustments

Attention: All Providers Effective Date: April 3, 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: As are result of the COVID-19 Disaster Declaration, TCHP has instituted the following changes to our authorization procedures. This alert is an update to our alert on April 2, 2020...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, SpecialistsCOVID, COVID-19, Prior Authorization, provider alert, provider alerts0 CommentsRead more...

03AprApril 3, 2020

Provider Alert! Patient Lifts

Attention: Primary Care and DME Providers Effective Date: July 3, 2020 Call to action: In accordance with Texas Medicaid Provider Procedure Manual (TMPPM), patient lifts will require prior authorization, except for E0637 & E0641when billed outside of the benefit limitations. Click here for the Prior Authorization Form. Coding information for lifts as an addition to the mobility aids that are already on the Prior Authorization list. Code Explanation E0630* Hydraulic//mechanical lift. This code has a limit of 1 purchase every 5 years and 1 month rental. E0635* Portable lift....

By Texas Children's Health PlanPrimary Care Providers, Provider Alert, Specialistslifts, Prior Authorization, provider alert, provider alerts0 CommentsRead more...

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