Prior Authorization – Page 14

02JanJanuary 2, 2019

Provider Alert! TCHP Prior Authorization Requirement

Effective January 1, 2019, TCHP will be updating the prior authorization listing. Please note there are some key changes for providers. Removed from the list and will no longer require prior authorization: Baclofen Pump New to the list: Home Telemonitoring Updates: Ambulance (non-emergent transport) has been updated to Non-Emergency Ambulance Transport. Augmentative Communication Device has been updated to Augmentative Communication Device and Accessories. Chemotherapy non-FDA approved has been updated to Non-FDA approved medications. Cranial Molding Orthosis (Helmets) has been updated to Cranial Molding Orthosis. High cost (>$50,000) injectable in the outpatient...

By Texas Children's Health PlanOB/GYNs, Office Managers, Primary Care Providers, Provider Alert, SpecialistsAuthorizations, Prior Authorization, provider alert0 CommentsRead more...

19DecDecember 19, 2018

Nutritional supplement guideline change

Effective 10/1/2018, Texas Children’s Health Plan will no longer require prior authorization for nutritional products for members 20 years and younger who: receive all or part of their nutritional intake through a tube as documented by ICD-10 codes (z43.1; z93.1, z93.4), OR have a metabolic disorder that has been documented with one of the diagnosis codes listed in the current TMPPM Section 2.2.17.2.2. Providers will retain the responsibility of maintaining appropriate documentation for the nutritional products supplied. A retrospective review may be performed...

By Texas Children's Health PlanPrimary Care Providers, SpecialistsDiet, Formula, Guidelines, Nutrition, Nutritional Supplements, Prior Authorization0 CommentsRead more...

02OctOctober 2, 2018

Provider Alert! Nutritional Supplement Guideline Change

By Texas Children's Health PlanOffice Managers, Primary Care Providers, Provider Alert, SpecialistsNutritional Supplements, Prior Authorization0 CommentsRead more...

03SepSeptember 3, 2018

Key Changes to TCHP Therapy Authorization Guidelines

When services were not prior authorized by Texas Children’s Health Plan, (through another MCO or TMHP) the authorization request must include: A copy of the previously approved authorization letter. All of the documentation that was sent in the original authorization request to the previous MCO or TMHP, including any physician orders that were used to determine the start of care. If the services requested do not meet TCHP criteria, the services will be honored for the shorter of 90 days or until expiration...

By Texas Children's Health PlanOffice Managers, Primary Care Providers, SpecialistsAuthorization, Authorizations, Guidelines, Prior Authorization, Therapy0 CommentsRead more...

20AugAugust 20, 2018

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 Texas Children's Health PlanOB/GYNs, Office Managers, Primary Care Providers, SpecialistsAntipsychotic Clinical Prior Authorization Edit, Navitus, Prior Authorization, Vendor Drug Program0 CommentsRead more...

05AugAugust 5, 2018

Provider Alert! Reminder: Authorization Requirements and Code Configuration

As a reminder, Texas Children’s Health Plan continues to require authorization for the following service categories: Bariatric surgery Circumcision in children 1 year of age and older General anesthesia for dental procedures for children 6 years and under (STAR and STAR Kids only) Oral surgery and medically necessary dental procedures Therapeutic and reconstructive breast procedures (including breast prosthesis) TMJ diagnosis and treatment Transplant services Providers will be able to access a complete list of codes that require an authorization in these categories on the Texas Children’s Health Plan...

By Texas Children's Health PlanOB/GYNs, Office Managers, Primary Care Providers, Provider Alert, SpecialistsAuthorization, Prior Authorization0 CommentsRead more...

17MayMay 17, 2018

Texas Standard Prior Authorization Form

Texas Children’s Health Plan prefers the submission of the Texas Standard Prior Authorization form for prior authorization requests, excluding LTSS services. Requests should also include supporting clinical documentation as per the Texas Children’s Health Plan Authorization Guidelines. The form is available on the Texas Children’s Health Plan website at http://www.texaschildrenshealthplan.org/for-providers/resources/downloadable-forms.

By Texas Children's Health PlanOB/GYNs, Office Managers, Primary Care Providers, Specialistsforms, Prior Authorization0 CommentsRead more...

01AprApril 1, 2018

Provider Alert! TCHP Prior Authorization Requirement

Subject: TCHP Prior Authorization Requirement Effective April 1, 2018, TCHP will be updating the prior authorization listing. This notice will serve as your 90-day advance notification of the change. Please note there are some key changes for providers. Removed from the list and will no longer require prior authorization: Walkers Vision Care, medically necessary New to the list: High cost injectable drugs (>$75K per dose) in an outpatient level of care require prior authorization. Examples include: Kymriah, Spinraza, Exondys Updates: Progesterone therapy has been updated to Hydroxyprogesterone caproate injections. Transplant...

By Texas Children's Health PlanOB/GYNs, Office Managers, Primary Care Providers, Provider Alert, SpecialistsPrior Authorization0 CommentsRead more...

17JanJanuary 17, 2018

Reminder on obtaining an authorization for genetic testing

Quest Diagnostics is the exclusive contracted lab for TCHP. For OB providers, all genetic testing requires prior authorization. Link to all services that require prior authorization: http://www.texaschildrenshealthplan.org/sites/default/files/pdf/Pre-Certification%20Requirements%20JULY%202017.pdf

By Texas Children's Health PlanOB/GYNs, Office Managers, Provider AlertAuthorizations, genetic testing, Prior Authorization0 CommentsRead more...

27SepSeptember 27, 2017

Provider Alert! Changes to physical, occupational and speech therapy benefits for all ages

Effective for dates of service on or after September 1, 2017, physical therapy (PT), occupational therapy (OT) and speech therapy (ST) benefits for all ages will change for Texas Medicaid. Please visit the TMHP website to review for changes to this medical benefit policy that applies to the following: Billing structure changes for PT, OT and ST services Procedure codes end-dating August 31, 2017 Required modifiers Claims filing changes Clarification to benefits Providers may refer to the current Texas Medicaid Provider Procedures Manual, Physical Therapy, Occupational Therapy...

By Texas Children's Health PlanProvider AlertBenefits, Fax Blast, occupational therapy, physical therapy, Prior Authorization, provider alert, speech therapy, Therapy0 CommentsRead more...

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