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 Average Wholesale Price (AWP) minus 10.5%. Curr ..read more

Date: June 12, 2024   Attention: All Providers Effective Date: July 1, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that on July 1, 2024, the Texas Medicaid & Healthcare Partnership (TMHP) will update the Texas Medicaid Provider Procedures Manual (TMPPM), Vision and Hearing Services Handbook to move diagnostic analysis procedure codes 92622 and 92623 from section 3.2.1, “Cochlear Implants,” to section 3.2.3, “Bone-Anchored Hearing Device (BAHD).” Procedure codes 92622 and 92623 may be reimbursed for diagnostic analysis of the cochle ..read more

Date: June 6, 2024 Attention: STAR Kids Providers/Consumer Directed Services employers, and FMSA Providers Call to action: Texas Children’s Health Plan would like to share that Texas Health and Human Services Commission (HHSC) is notifying program providers and financial management services agencies (FMSAs) who are interested in the opportunity to participate and complete the Proprietary System Operator (PSO) Onboarding process this calendar year (2024) that they must submit a Proprietary System (PS) Request Form by July 15, 2024. The PS Request Form can be submitted at any time, but avai ..read more

Date: June 6, 2024 Attention: All Providers Effective for dates of service on or after: July 1, 2024 Call to action: The purpose of this communication is to inform providers that effective for dates of service on or after July 1, 2024, the age requirement for prior authorization of inotuzumab ozogamicin (Besponsa) (procedure code J9229) will be expanded to include pediatric and adult clients who are one year of age or older. How this impacts providers: Providers should reference the current Texas Medicaid Provider Procedures Manual (TMPPM) Outpatient Drug Services Handbook, subsection 6.67.1 ..read more

Date: June 3, 2024 Attention: All Providers Effective Date: September 1, 2024 Call to action: The purpose of this communication is to make providers aware of a new reimbursement policy for Texas Children’s Health Plan (TCHP), which outlines and standardizes reimbursement for emergency room (ER) services.  This policy is for general acute care hospitals that do not have emergency room services defined in their contract. This applies to CHIP and Medicaid lines of business. How this impacts providers: Policy guidelines are as follows: ER services (upper level and lower level) provided in a h ..read more

Date: May 31, 2024 Attention: Providers Effective date: May 8 and May 10, and May 16, 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 May 8, 2024, May 10, and May 16, 2024. National Drug Code Drug Name Effective Date 00173090442 NUCALA 40 MG/0.4 ML SYRINGE 5/8/2024 15370030560 POKONZA 10 MEQ PACKET 5/8/2024 64406003002 ZURZUVAE 25 MG CAPSULE 5/10/2024 64406003101 ZURZUVAE 30 MG CAPSULE 5/10/2024 68682013350 CLINDAMYC-BNZ PEROX 1.2-3.7 5/10/2024 72786010202 OX ..read more

Date: May 28, 2024 Attention: All Providers Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that on May 17, 2024 Health and Human Services Commission (HHSC) published an updated Hormonal Therapy Agents Clinical prior authorization criteria guide that was originally implemented on March 1, 2024. Previous TCHP provider alerts on hormonal therapy agents: Clinical Implementation of Hormonal Therapy Agents Clinical Prior Authorization Effective March 1, 2024: https://www.thecheckup.org/2024/02/02/provider-alert-clinical-implementation-of-hormonal-therapy-agents-cl ..read more

Date: May 21, 2024 Attention: Prescribers Event date: June 13, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to inform prescribers of an upcoming webinar called Treating Hepatitis C in Your Practice hosted by Mavyret manufacturer, AbbVie. This is in support of the Health and Human Services (HHSC) initiative to improve awareness, screening, diagnosis, and treatment of the Hepatitis C Virus for Medicaid clients. Event details for webinar Treating Hepatitis C in Your Practice: Date: Thursday, June 13, 2024 Time: 12:15PM CST Registration: myattendeeresource.com/AbbVie/24 ..read more

Date: May 20 2024 Attention: All Providers Effective Date: March 1, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective for dates of service on or after March 1, 2024, maintenance dialysis benefits changed for Texas Medicaid.  Maintenance Hemodialysis, IPD, CCPD, and CAPD The number of peritoneal dialysis treatments for continuous ambulatory peritoneal dialysis (CAPD) or continuous cycling peritoneal dialysis (CCPD) in the home is limited to 14 sessions within 31 days. This limit is set regardless of the number of dialysate exchanges that ..read more

Call to action: We would like to introduce Texas Children’s Health Plan’s (TCHP) new Fraud, Waste, and Abuse Hotline, a dedicated resource designed specifically for our Network Providers. We understand the critical importance of maintaining the highest standards of integrity and compliance within our healthcare network. The New Hotline is 866-828-4924, or visit https://tchpintegrity.com/. How this impacts providers: Our hotline offers a secure and confidential way for providers to report any issues or concerns related to compliance, fraud, waste, or abuse. Whether you witness suspicious a ..read more