Monthly Archives - June 2024

Provider Alert!
25Jun

Provider Alert! Texas Children’s Provider Portal Now Accessible to Out-of-Network Providers

Date: June 25, 2024 Attention: Out of Network Providers Call to action: Texas Children’s Health Plan (TCHP) is excited to announce that out-of-network providers can now request access our provider portal, Texas Children’s® Link to review and download Electronic Remittance Advice (aka Explanation of Payments/Explanation of Billing). These users will ONLY be allowed to review ERA. Steps for requesting access:  Visit https://www.texaschildrenshealthplan.org/providers/link-provider-portal Click “Access Texas Children’s Link” Click “Request New Account” button towards the bottom left hand side of the screen and complete the request form. Utilize...

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Provider Alert!
25Jun

Provider Alert! Texas Children’s Health Plan Announces Partnership with Cotiviti

Date: June 24, 2024 Attention: All Providers Effective Date: October 1, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that beginning October 1, 2024, we will partner with Cotiviti, Inc (Cotiviti) for periodic post payment reviews of paid medical claims. The post payment reviews to be conducted are: Retrospective Clinical Claim Validation (RCCV) DRG, observation, and readmission reviews. These are the same/similar reviews that are currently being conducted, just with a new vendor, Cotiviti. What providers can expect: CCV...

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Provider Alert!
24Jun

Provider Alert! Texas Children’s Promotes Positive Adolescent Health

Date: June 21,2024 Attention: All Providers Call to action: Texas Children’s Health Plan (TCHP) regards counseling and treatment for adolescent care as extremely important, especially in Behavioral Health. A patient’s impression of their visit directly impacts their compliance with aftercare and overall health outcome. How this impacts providers: The best way for patients to feel they are receiving the best care possible is to have clear communication with their provider by implementing effective clinical practices. Based on the 2023 Experience of Care and...

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Provider Alert!
21Jun

Provider Alert! Co-pays for CHIP COVID-19 services will resume starting October 1, 2024

Date: June 21, 2024 Attention: All Providers Effective Date: October 1, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that beginning October 1, 2024, providers may begin collecting Children’s Health Insurance Program (CHIP) co-pays for COVID-19 related services. As you know, during the COVID-19 public health emergency, the Texas Health and Human Services Commission (HHSC) waived co-pays for COVID-19 vaccines, testing, and treatment for CHIP members. This waiver will end on September 30, 2024. Important reminders regarding co-payment for...

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Provider Alert!
21Jun

Provider Alert! Update & Revision for Drugs Added to Medicaid, CHIP Formularies

Date: June 21, 2024 Attention: All Providers Effective dates: June 6; June 12, 2024 for ESOMEPRAZOLE MAG DR 20 MG C Call to action: This is an update to communication that was previously posted on June 18, 2024. Texas Children’s Health Plan would like to inform providers that the Vendor Drug Program added the new drugs to the table available below, effective June 6; June 12, 2024 for ESOMEPRAZOLE MAG DR 20 MG C. Background:Vendor Drug Program (VDP) added new NDCs to the Medicaid and...

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Provider Alert!
18Jun

Provider Alert! Drugs Added to Medicaid, CHIP Formularies on June 6, 2024

Date: June 18, 2024 Attention: All Providers Effective date: June 6, 2024 Call to action: Texas Children’s Health Plan would like to inform providers that the Vendor Drug Program added the new drugs to the table available below, effective June 6, 2024. National Drug CodeDrug NamePDL Status62135099260ZIPRASIDONE HCL 40 MG CAPSULEPDL (preferred)62135099160ZIPRASIDONE HCL 20 MG CAPSULEPDL (preferred)62135099360ZIPRASIDONE HCL 60 MG CAPSULEPDL (preferred)62135099460ZIPRASIDONE HCL 80 MG CAPSULEPDL (preferred)62135004190FOSINOPRIL SODIUM 10 MG TABPDL (preferred)69097099205DILTIAZEM 24H ER(LA) 120 MG TBNPD (non-preferred)69097099305DILTIAZEM 24H ER(LA) 180 MG TBNPD (non-preferred)69097099405DILTIAZEM...

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Provider Alert!
18Jun

Provider Alert! You’re Invited to Our Provider Advisory Group!

Date: June 18, 2024 Attention: All Providers Event dates for the upcoming sessions Tuesday, September 24, 2024Tuesday, December 10, 2024All sessions will be from 12:00-1:30PM CST Call to action: Texas Children’s Health Plan (TCHP) invites you to join our quarterly Provider Advisory Group (PAG). We will hold our next session in September. We have updated the organization of the sessions. We will now hold one for all three Service Delivery Areas combined each quarter. Sessions will be held online as a Microsoft Teams...

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Provider Alert!
17Jun

Provider Alert! Texas Children’s Health Plan Highlights Patient Communication

Date: June 17, 2024 Attention: All Providers Call to action: Texas Children’s Health Plan (TCHP) would like to highlight the topic of patient communication this month with our providers. One aspect of patient communication, Motivational Interviewing, has been known to aid in promoting healthy habits and optimizing self-care. “Health coaching, its origin from motivational interviewing, enhances patient self-management of chronic conditions by improving patient compliance and outcomes, and reducing costs.” Source: https://pubmed.ncbi.nlm.nih.gov/19745624/ Background information: Based on the 2023 Experience of Care and Health...

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Provider Alert!
14Jun

Provider Alert! Reminder about EVV Home Phone Landline Requirements

Date: June 14, 2024 Attention: STAR Kids Providers/Consumer Directed Services employers, and FMSA Providers Call to action: Texas Children’s Health Plan would like to remind program providers, financial management services agencies (FMSAs), and Consumer Direct Services (CDS) employers about the Electronic Visit Verification (EVV) home phone landline requirements. The EVV Home Phone Landline Requirements policy requires the use of an approved allowable phone type when a program provider has selected the member’s home phone landline as the clock in and clock out...

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Provider Alert!
12Jun

Provider Alert! Maximum Allowable Update for Non-Risk Based Drugs Billed With ‘Unclassified’ Procedure Codes

Date: June 12, 2024 Attention: All Providers Call to action: The Texas Health and Human Services Commission (HHSC) would like to disclose the maximum allowable reimbursement for Non-Risk drugs currently payable under an ‘Unclassified’ procedure code as referenced in the National Drug Code to Healthcare Common Procedure Coding System (NDC to HCPCS) crosswalk. How this impacts providers: HHSC bases the pricing for an outpatient medical claim for an ‘Unclassified’ procedure code on the lesser of the manufacturer’s suggested retail price minus 18% or...

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