Notices for Providers | Texas Children's Health Plan
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Notices for Providers

Provider Alert! Reminder: Texas Children’s Health Plan Claim Editing System Update

 
 

Disaster Alert:

On April 18, 2019: Governor Greg Abbott issued a disaster declaration for the following counties Cherokee, Freestone, Houston, Leon, Madison, Nacogdoches, Robertson, San Augustine, and Shelby counties. If a member resides in one of these impacted areas named above Texas Children’s Health Plan will make every effort to assist them in obtaining medically necessary services. 
 
PHARMACY:  Navitus Pharmacy update related to disaster declaration:
 
Navitus has implemented the "Disaster Declaration and Refill Too Soon" process as a result of the severe weather, including thunderstorms and tornado events in the State of Texas. As part of our process the Refill Too Soon (RTS) rejects have been lifted so that members who are affected are able to access their medications without disruption. As part of invoking this process, the RTS edits are lifted at a member zip code level so if a member resides in an affected zip code they can go to any pharmacy in our service area (even out of their home state) and obtain medications without having to receiving a rejection. These RTS edits are lifted for the timeframe of April 12, 2019 to May 12, 2019.  These edits are currently lifted for all lines of business.
 
Additional information will be posted as it becomes available.    

Portal Use for Non-Contracted Providers

Texas Children’s Health Plan has a commitment to provide maximum security of member information, and a pledge to adhere to HIPAA privacy guidelines. Beginning September 1, 2018, we discontinued the access for non-contracted providers to the online provider portal. For non-contracted providers that currently have access, as your account is due for renewal, access will not be renewed. We apologize for any inconvenience this may cause. You may contact the Provider hotline at 832-828-1008 or Toll free: 1-800-731-8527.
 

To inquire about becoming a contracted provider please complete a Letter of Interest form and submit a W-9.
 

The Texas Children’s Health Plan Network Management Department will review to ensure the following criteria are met:
 

  • Provider is a Texas Medicaid Provider, as applicable
  • Provider delivers service in one of the Texas Children’s Health Plan service areas
  • Provider has admitting privileges at a participating hospital within Texas Children’s Health Plan’s provider network, as applicable
  • Service provided is an identified network need for Texas Children’s Health Plan

Provider Notification: Credentialing Using Availity

April 1, 2018, Texas Children’s Health Plan is now using Availity, a credentialing application portal, for implementation of the Credentialing Verification Organization (CVO).

 

On April 12, a webinar training will be offered to providers to instruct on the new credentialing process using he Availity portal. This training is for providers who have already registered with Availity, and will be an in-depth training on how to use the Credentialing tool.

 

Instructions to Enroll in Training Webinar:

 

To enroll for the Credentialing on the Availity Portal webinar training on April 12, 2018 at 3:00 p.m. CT:

 
  1. If not yet registered for Availity, go to www.Availity.com, click Register in the top right of the page, then follow the organization registration process. Once your registration is approved you can proceed to the next step.
  2. To enroll for the April 12, 2018 live webinar, Credentialing on the Availity Portal for TAHP Providers, click here then log in to your Availity account. A separate tab will open directly on the enrollment page for this webinar. Click Enroll at the top right of the page.

Once enrolled, you will receive a confirmation email as well as a reminder email prior to the event.


How to update member information if they have moved:
 

All address changes must be reported to HHSC. Members can contact HHSC by calling 2-1-1 or by updating their account on YourTexasBenefits.com.
 

It is important to make sure address information is updated in a timely manner to ensure families continue to receive information from Texas Children’s Health Plan and HHSC. If a member has moved to an area that is not covered by Texas Children’s Health Plan they will need to select a new health plan. If a family is unsure if they have moved to an area that is outside of Texas Children’s Health Plan’s service area, we can help them by connecting them to HHSC so the address change can be made. Members will continue to have access to care through Texas Children’s Health Plan until HHSC changes their address.
 

If a Member needs help, call Member Services toll-free at 1-866-959-2555 (STAR), 1-866-959-6555 (CHIP), or 1-800-659-5764 (STAR Kids).

 

Hospitals Billing Neonatal Claims Must Submit Application for Neonatal Level of Designation before July 1, 2018

Effective immediately, hospitals rendering neonatal services must submit their neonatal designation applications to the Texas Department of State Health Services.

  • Completed applications must be submitted before July 1, 2018.
  • Applications received after July 1 will not be considered for approval. If an application is received after July 1, it will not be considered as submitted in time for approval by the executive commissioner before the August 31 deadline.
  • Each hospital provider location is considered separately for designation.

There is no grace period for Medicaid reimbursement payments if a facility is not designated.

 

For additional information, application information and Texas Administrative Code, Title 25, Chapter 133, Subchapter J, please click here


Provider Notification: Credentialing Using Availity

April 1, 2018, Texas Children’s Health Plan is now using Availity, a credentialing application portal, for implementation of the Credentialing Verification Organization (CVO).

 

On April 12, a webinar training will be offered to providers to instruct on the new credentialing process using he Availity portal. This training is for providers who have already registered with Availity, and will be an in-depth training on how to use the Credentialing tool.

 

Instructions to Enroll in Training Webinar:

 

To enroll for the Credentialing on the Availity Portal webinar training on April 12, 2018 at 3:00 p.m. CT:

 

  1. If not yet registered for Availity, go to www.Availity.com, click Register in the top right of the page, then follow the organization registration process. Once your registration is approved you can proceed to the next step.
  2. To enroll for the April 12, 2018 live webinar, Credentialing on the Availity Portal for TAHP Providers, click here then log in to your Availity account. A separate tab will open directly on the enrollment page for this webinar. Click Enroll at the top right of the page.

Once enrolled, you will receive a confirmation email as well as a reminder email prior to the event.


New Vision Services Provider

Effective April 1, 2018, Envolve Vision will provide routine vision services for all members. If you have any questions about vision benefits, please call Envolve Vision. The following toll-free numbers apply to both providers and members.

 

CHIP: 1-844-520-3711
STAR: 1-844-683-2305
STAR Kids: 1-844-212-7269


Hurricane Harvey Update

Effective August 25, 2017, Pharmacy and Provider copays will be waived for members in the FEMA declared disaster counties.
 

Visit HHSC's website Hurricane Harvey Information for Providers
 

Updated - Hurricane Harvey Medicaid and Children's Health Insurance Program (CHIP) Frequently Asked Questions for Managed Care Organizations (MCOs)


Medicaid Fraud Notice

read more...


Adoption Assistance

Effective 09/01/2017 Adoption Assistance members are required to enroll in managed Medicaid and will be new members with Texas Children’s Health Plan STAR or STAR Kids programs.

Provider Alert: Adoption Assistance


STAR Kids Billing Matrix

The STAR Kids billing matrix has been updated to include the registered nurse modifier (TD) to the private duty nursing (PDN) billing code, T1000. Additionally, the billing codes for PDN independently enrolled LVNs and RNs have been added to the matrix. The Revenue Code 663 was added to the Out-of-Home Respite codes. Attached is the updated billing matrix, which will be added to the handbook. This billing matrix will become effective on June 5, 2017.

 

June 5, 2017 Billing Matrix

LTSS Billing Procedures

STAR Kids Handbook

Long Term Care Provider Bulletin, No. 69

Contact Provider Relations


Effective April 1: EVV Compliance Score Must be 90%

Beginning April 1, 2017, providers required to use Electronic Visit Verification (EVV) will be required to meet the minimum EVV compliance score of 90% as outlined in the EVV Provider Compliance Plan. Providers were required to meet the minimum score of 75% for the first year of compliance from April 1, 2016, through March 31, 2017. Questions about this alert can be sent to: tchpprovrel@texaschildrens.org


Texas Health Steps Regional Representative Contact List

Click for THSteps Regional Provider Relations Representatives


THSteps Documentation Improvement

As a Texas Health Steps (THSteps) provider, you affect the lives of many young Texans, and the Health and Human Services Commission (HHSC) understands documenting the THSteps components of the checkup can be challenging. One federal and two state contracted reviews of medical records have shown that missing documentation is the largest factor and the primary cause of records being reviewed and money being recouped. HHSC would like to assist you in documenting all of the required components and elements of the THSteps checkups in order to reflect the work you perform to complete each checkup. | read more...


Patient Protection And Affordable Care Act Deadline Has Passed And Dis-enrollment From Texas Medicaid Will Occur January 31, 2017

The Patient Protection and Affordable Care Act (PPACA) requires providers to have revalidated their enrollment in state Medicaid programs by September 24, 2016. In accordance with PPACA and based on direction from the Texas Health and Human Services Commission (HHSC),TMHP has accepted and is processing completed revalidation applications received by September 24, 2016. | read more...   


THsteps Checkup Documentation -- Essential to Medical Records

As a Texas Health Steps (THSteps) provider you affect the lives of many young Texans. The care you provide helps prevent serious or chronic health-care problems and often helps young patients begin to develop positive lifelong health-care habits. Being a THSteps provider can be very rewarding. It can also be very challenging, especially when it comes to medical checkup documentation. | read more...