Banner Messages for All of the 2017 R&S ReportsThis file contains abbreviated messages meant to provide timely notifications that affect all provider groups (physicians, dentists, and so forth). Expanded articles are posted on the TMHP website at www.tmhp.com. This file provides links to the expanded articles. Short, complete messages will not have links to the website.
Copyright Acknowledgements
Use of the AMA’s copyrighted CPT® is allowed in this publication with the following disclosure:“Current Procedural Terminology (CPT) is copyright 2017 American Medical Association. All rights reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable Federal Acquisition Regulation System/Defense Federal Acquisition Regulation Supplement (FARS/DFARS) apply.”
“Microsoft® and Windows® are either registered trademarks or trademarks of Microsoft Corporation in the United States and/or other countries.”
Total Messages (All for 2017)
1 (12/16/16 through 01/06/17) *****Attention Medicaid Providers*****Effective for dates of service on or after January 1, 2017, benefit criteria will change for diagnostic Doppler sonography for Texas Medicaid. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
2 (12/16/16 through 01/06/17) *****Attention Medicaid Providers*****Effective for dates of services on or after January 1, 2016, January 1, 2017, and March 1, 2017, proposed reimbursement rate changes and updates for some procedure codes were presented at a public rate hearing on November 16, 2016. Implementation of these reimbursement rates is pending; providers will be notified when a final decision has been made.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
3 (12/16/16 through 01/06/17) *****Attention Medicaid Providers*****Effective for dates of service on or after January 1, 2017, proposed reimbursement rate changes for procedure codes included in the 2017 Annual Healthcare Common Procedure Coding System (HCPCS) update will be presented at a public rate hearing on January 11, 2017. Implementation of these reimbursement rates is pending; providers will be notified after the rate hearing when a final decision has been made.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
4 (12/16/16 through 01/06/17) *****Attention Medicaid Providers*****Effective for dates of service on or after February 1, 2017, proposed reimbursement rate changes for Diagnostic Radiology Services, which includes Hospital Outpatient Diagnostic Radiology Services, will be presented at a public rate hearing on December 15, 2016. Implementation of these reimbursement rates is pending; providers will be notified after the rate hearing when a final decision has been made. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
5 (12/16/16 through 1/06/17) *****Attention All Healthy Texas Women Providers*****Effective for dates of service on or after December 1, 2016, some procedure codes may be reimbursed to federally qualified health centers (FQHCs) for three encounter payments per Healthy Texas Women (HTW) client per year. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
6 (12/16/16 through 01/06/17) *****Attention Medicaid Providers*****The HHSC Inspector General-Utilization Review (IG-UR) Unit has revised the Diagnosis Related Group (DRG) Validation process in compliance with Senate Bill 207, 84th Legislature (2015). Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
7 (12/16/16 through 1/06/17) *****Attention CSHCN Services Program Providers*****Effective November 29, 2016, the Children with Special Healthcare Needs (CSHCN) Services Program added mosquito repellent as a covered drug benefit for eligible clients. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
8 (12/16/16 through 01/06/17) *****Attention CSHCN Services Program Providers*****Effective for dates of service on or after December 15, 2016, the Children with Special Healthcare Needs (CSHCN) Services Program will align with Texas Medicaid reimbursement rate changes and updates for Therapy Services. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
9 (12/23/16 through 01/13/17) *****Attention All Medicaid Providers*****There is a correction to the current Texas Medicaid Provider Procedures Manual, Women's Health Services Handbook, subsection 2.3.4, "Laboratory Procedures." This subsection incorrectly listed procedure code 84780, and it has been updated to list the correct procedure code 87480.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
10 (12/23/16 through 01/13/17) *****Attention THSteps Providers*****Effective for dates of service on or after January 1, 2017, Texas Health Steps (THSteps) mental health screening procedure code 99420 will be discontinued by the Centers for Medicare and Medicaid Services (CMS) in accordance with the 2017 annual Healthcare Common Procedure Coding System (HCPCS) update. Procedure code 99420 will be replaced by two new procedure codes, 96160 and 96161. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
11 (12/23/16 through 01/13/17) *****Attention Medicaid Providers*****This is an update to the article titled "Delay in Date on which PPECC Prior Authorization Request May be Submitted," which was posted on this website on November 10, 2016. The Prescribed Pediatric Extended Care Center (PPECC) services benefit continues to be delayed. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
12 (12/23/16 through 01/13/17) *****Attention Medicaid Providers*****Effective December 9, 2016, the following prior authorization forms have been updated and are now available as fillable PDFs on this website and on TMHP's Prior Authorization on the Portal (PA on the Portal): CCP Prior Authorization Request Form and instructions, Home Health Plan of Care (POC) form and instructions, and Nursing Addendum to Plan of Care for Private Duty Nursing and/or Prescribed Pediatric Extended Care Centers. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
13 (12/23/16 through 01/13/17) *****Attention All Healthy Texas Women Providers*****This is a correction to the article titled, "Effective December 1, 2016, Procedure Codes Reimbursement Update for FQHCs Treating HTW Clients." The correction is that procedure code J298 that is listed in the "Note" section of the article is missing a number. The correct procedure code is J7298. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
14 (12/23/16 through 01/13/17) *****Attention All FQHC Providers*****There is a correction to the current Texas Medicaid Provider Procedures Manual, Women's Health Services Handbook, subsection 2.3.3.1, "FQHC Reimbursement for Other Family Planning Office or Outpatient Visits." This subsection incorrectly stated that Federally Qualified Health Centers (FQHCs) may be reimbursed for three family planning encounters per Healthy Texas Women (HTW) client, per year. The correct statement is: FQHCs may be reimbursed for three encounters per HTW client, regardless of service type, per year.For more information, call the TMHP Contact Center at 1-800-925-9126.
15 (12/30/16 through 01/20/17) *****Attention All CSHCN Services Program Providers*****Effective for dates of service on or after January 1, 2017, certain CSHCN Services Program procedure codes will be updated as follows: authorization and prior authorization requirements have been removed from some procedure codes and added for some procedure codes. The type of service has changed for some procedure codes or has been made not a benefit.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
16 (12/23/16 through 01/13/17) *****Attention Medicaid Providers*****Effective for dates of service on or after January 1, 2017, the microsurgery add-on procedure code 69990 will be a benefit of Texas Medicaid.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
17 (12/23/16 through 01/13/17) *****Attention CSHCN Services Program Providers*****Effective for dates of service on or after January 1, 2017, the microsurgery add-on procedure code 69990 will be a benefit of the Children with Special Health Care Needs (CSHCN) Services Program.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
18 (12/30/16 through 01/20/16) *****Attention All Providers*****TMHP will perform scheduled maintenance on Sunday, February 12, 2017, from 4:00 p.m. until 11:59 p.m. All applications and functions will be unavailable during the system maintenance window.For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
19 (12/30/16 through 01/20/16) *****Attention Medicaid Providers*****This is an update to the articles titled, "Procedure Code Updates for Dual-Eligible Clients Effective June 1, 2016 and August 1, 2016," and "Update to 'Procedure Code Updates for Dual-Eligible Clients Effective June 1, 2016 and August 1, 2016,"" which were published on the TMHP website May 25, 2016, and July 27, 2016.Effective January 1, 2017, some additional procedure codes are covered benefits of Medicare, and they must be submitted to Medicare before they are submitted to Medicaid for clients who are eligible for Medicare and Medicaid (i.e., dual-eligible clients).Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
20 (12/30/16 through 01/20/17) *****Attention All Medicaid Providers*****There is a reminder article about allergy testing benefits for Texas Medicaid.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
21 (12/30/16 through 01/20/17) *****Attention All Medicaid Providers*****On January 5, 2017, the Vendor Drug Program (VDP) will modify clinical prior authorization on all buprenorphine and buprenorphine/naloxone combination products by changing the duration from 30 days to 90 days. The duration modification is a result of prescriber feedback. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
22 (12/30/16 through 1/20/17) *****Attention All Providers*****The Texas Health and Human Services Commission has expanded the mosquito repellent benefit for Zika virus prevention beyond December 31, 2016, for residents of Cameron County. The expansion is for all programs previously covered by the benefit, including fee-for-service (FFS) Texas Medicaid, Medicaid Managed Care (MCO), Children's Health Insurance Program (CHIP), the Healthy Texas Women (HTW) program, and the Children with Special Health Care Needs (CSHCN) Services Program. This also includes the Texas Standing Order for Medicaid and CHIP eligible individuals. Details are available on the TMHP website at www.tmhp.com. [link]
For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
23 (01/06/17 through 01/27/17) *****Attention All Medicaid and CSHCN Services Program Providers*****
Effective January 1, 2017, the first quarter 2017 National Correct Coding Initiative (NCCI) updates will be implemented for claims processed by TMHP for Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
24 (01/06/17 through 01/27/17) *****Attention All Medicaid and CSHCN Services Program Providers*****
Beginning January 1, 2017, changes will be made to the outstanding checks process for Texas Medicaid and the Children with Special Health Care Needs (CSHSN) Services Program providers. Providers that have not cashed their checks within 180 days of the issue date may submit a void check appeal to TMHP Cash Financial. The appeal is not a guarantee of payment.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126, or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
25 (1/06/17 through 1/27/17) *****Attention Medicaid Providers*****The Texas Medicaid Quick Reference Guide has been updated to include the 2017 filing deadline calendar.For more information, call the TMHP Contact Center at 1-800-925-9126.
26 (01/06/17 through 01/27/17) *****Attention All Medicaid Providers*****Effective January 1, 2017, as a condition of enrollment in Texas Medicaid and in accordance with Title 42 Code of Federal Regulations (CFR) §455.434 and §455.450(c), fingerprint-based background checks are required for all high-categorical risk providers and their owners who have a 5 percent or greater direct or indirect ownership interest. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
27 (01/13/17 through 02/03/17) *****Attention All Medicaid Providers*****Effective January 27, 2017, Texas Medicaid will implement the semi-annual update of the Medicaid preferred drug list (PDL). The update is based on changes presented at the July and October 2016 Drug Utilization Review (DUR) Board meetings.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
28 (12/30/16 through 01/20/17) *****Attention All Healthy Texas Women Providers*****This is a correction to the article titled "Correction to 'Effective December 1, 2016, Procedure Codes Reimbursement Update for FQHCs Treating HTW Clients.'" The correction is that the original article should have included procedure code J7307 as a reimbursable code in addition to the federally qualified health center (FQHC) encounter payment. The previous correction article only mentioned that procedure code J7298 was missing a digit in the original article. Details are available on the TMHP website on www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
29 (01/13/17 through 02/03/17) *****Attention All Family Planning Providers*****Effective December 23, 2016, procedure codes 11982 and 11983 are benefits of the state-funded Family Planning Program (FPP) for dates of service on or after July 1, 2016.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
30 (01/06/17 through 01/27/17) *****Attention All Medicaid Providers*****Effective for dates of service on or after January 1, 2017, the timeframe for written and verbal orders will change for Texas Medicaid Physical, Occupational, and Speech Therapy - Adult/Clients Age 21 and Over benefits and for Texas Medicaid Physical, Occupational, and Speech Therapy-Children (Acute and Chronic) benefits. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
31 (01/06/17 through 01/27/17) *****Attention All Medicaid Providers*****Effective for dates of service on or after January 1, 2017, physical therapy (PT) evaluation procedure code 97001 and reevaluation procedure code 97002, and occupational therapy (OT) evaluation procedure code 97003 and reevaluation procedure code 97004 are being discontinued by the 2017 Healthcare Common Procedure Coding System (HCPCS) code updates. The changes for these procedure codes will impact Texas Medicaid PT and OT services. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
32 (01/06/17 through 01/27/17) *****Attention All ECI Providers*****Effective for dates of service on or after January 1, 2017, physical therapy (PT) evaluation procedure code 97001 and reevaluation procedure code 97002, and occupational therapy (OT) evaluation procedure code 97003 and reevaluation code 97004 are being discontinued by the 2017 Healthcare Common Procedure Coding System (HCPCS) code updates. The changes for these procedure codes will impact Early Childhood Intervention (ECI) providers. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
33 (01/06/17 through 01/27/17) *****Attention All SHARS Providers*****Effective for dates of service on or after January 1, 2017, physical therapy (PT) evaluation procedure code 97001 and occupational therapy (OT) evaluation procedure code 97003 are being discontinued by the 2017 Healthcare Common Procedure Coding System (HCPCS) code updates. These procedure code changes will impact School Health and Related Services (SHARS) providers. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
34 SR- 6160432Banner/Website(01/06/17 through 01/27/17) *****Attention All Medicaid Providers*****Effective for dates of service on or after January 1, 2017, modifier 95 must be appended to all Texas Medicaid and CSHCN Services Program procedure codes billed as a telemedicine or telehealth service. Modifier GT will no longer be used for Texas Medicaid and CSHCN Services Program telemedicine services. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
35 (01/06/17 through 01/27/17) *****Attention All Medicaid Providers*****Effective for dates of service on or after January 1, 2017, procedure codes 97001 and 97003 will be discontinued by the 2017 Healthcare Common Procedure Coding System (HCPCS) code updates. Previously, procedure codes 97001 and 97003 with modifier U1 were used to bill for reimbursement of a seating assessment, including assessments for wheelchairs, scooters, and strollers, when billed by an occupational therapist (OT) or a physical therapist (PT). Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
36 (01/13/17 through 02/03/17) *****Attention All Medicaid Providers*****Effective for dates of service on or after March 1, 2017, benefit criteria will change for Respiratory Equipment and Supplies for Texas Medicaid. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
37 (01/13/17 through 02/03/17) *****Attention All Medicaid Providers*****Effective for dates of service on or after March 1, 2017, benefit criteria will change for cardiorespiratory monitor (CRM) for Texas Medicaid. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
38 (01/13/17 through 02/03/17) *****Attention All Medicaid Providers*****Effective for dates of service on or after March 1, 2017, benefit criteria will change for continuous positive airway pressure (CPAP) and respiratory assist devices (RADs) for Texas Medicaid. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
39 (01/13/17 through 02/03/17) *****Attention All Medicaid Providers*****Effective for dates of service on or after March 1, 2017, benefit criteria will change for humidifiers and heating elements for Texas Medicaid. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
40 (01/13/17 through 02/03/17) *****Attention All Medicaid Providers*****Effective for dates of service on or after March 1, 2017, benefit criteria will change for mechanical ventilation equipment for Texas Medicaid. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
41 (01/13/17 through 02/03/17) *****Attention All Medicaid Providers*****Effective for dates of service on or after March 1, 2017, benefit criteria will change for oxygen therapy for Texas Medicaid. Details are available on the TMHP website at www.tmhp.com. [link]
For more information, call the TMHP Contact Center at 1-800-925-9126.
42 (01/13/17 through 02/03/17) *****Attention All Medicaid Providers*****Effective for dates of service on or after March 1, 2017, benefit criteria will change for Pulse Oximeters for Texas Medicaid. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
43 (01/13/17 through 02/03/17) *****Attention All Medicaid Providers*****Effective for dates of service on or after March 1, 2017, benefit criteria will change for secretion and mucus clearing devices for Texas Medicaid. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
44 (01/13/17 through 02/03/17) *****Attention Medicaid Providers*****Effective for dates of service on or after March 1, 2017, benefit criteria will change for small volume and ultrasonic nebulizers for Texas Medicaid.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
45 (01/03/17 through 02/03/17) *****Attention Medicaid Providers*****The Texas Medicaid & Healthcare Partnership (TMHP) has introduced several new forms for requesting prior authorization of respiratory services. The new forms will be available on the TMHP website in January 2017; however, the forms will not be effective until March 1, 2017. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
46 (01/06/17 through 01/27/17) *****Attention All Medicaid Providers*****TMHP has updated several provider enrollment applications, forms, and documents. The revised versions will be available on the TMHP website beginning January 3, 2017. The changes to the applications are also reflected in Provider Enrollment on the Portal (PEP).Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
47 (01/03/17 through 02/03/17) *****Attention Medicaid Providers*****TMHP has upgraded to the latest version of the All Patient Refined-Diagnosis Related Groups (APR-DRG) grouper software, which was released on November 17, 2016. The 2016 3.2 version of the software includes updates to the APR DRG v34 grouper. TMHP made the updated software version available on December 30, 2016. Due to updates in the APR DRG v34 grouper, TMHP will analyze and identify impacted inpatient claims by this update.For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
48 (01/13/17 through 02/03/17) *****Attention Medicaid Providers*****This is an update to an article titled, "Reimbursement Rates Changes and Updates for Texas Medicaid to Be Effective January 1, 2016, January 1, 2017, and March 1, 2017," which was published on the TMHP website on December 5, 2016.Effective for dates of services on or after January 1, 2016, January 1, 2017, and March 1, 2017, reimbursement rate changes and updates for some procedure codes that were presented at a public rate hearing on November 16, 2016, are now available.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
49 (01/06/17 through 01/27/17) *****Attention All Medicaid Providers*****Effective for dates of service on or after February 1, 2017, benefit criteria for noninvasive prenatal screening procedure codes 81420 and 81507 will change for Texas Medicaid.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
50 (01/20/17 through 02/10/17) *****Attention All Medicaid Providers*****Benefit criteria for health and behavior assessment and intervention services will be clarified for Texas Medicaid for dates of service on or after March 1, 2017.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
51 (01/20/17 through 02/10/17) *****Attention Medicaid Providers*****This is a correction to an article titled, "Update to 'Reimbursement Rates Changes and Updates for Texas Medicaid to Be Effective January 1, 2016, January 1, 2017 and March 1, 2017,'" which was published on the TMHP website on January 5, 2017.In the original article, tables for Indian Health Services, combination type of service 1-2-I-T (medical services, surgery, and interpretation and technical components), long acting reversible contraceptives
(LARCs) (devices only), medical nutrition therapy and outpatient behavioral health had incorrect effective dates.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
52 (01/06/17 through 01/27/17) *****Attention All Medicaid Providers*****There is an update to the article titled, "Outpatient Mental Health Services to Change for Texas Medicaid," which was published on the TMHP website November 2, 2016. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
53 (01/20/17 through 02/10/17) *****Attention All Medicaid and CSHCN Services Program Providers*****
Providers are encouraged to participate in a seven question survey concerning the TMHP contact center and the TMHP website. The information gathered through this survey helps TMHP to serve providers better by confirming services that are working well, identifying services that could be improved, and suggesting additional resources that could serve the needs of state health-care providers. The date that providers can access the survey has been extended to February 15, 2017. Details are available on the TMHP website at www.tmhp.com. [link]
54 (01/20/17 through 02/10/17) *****Attention All Medicaid Providers*****Effective for dates of service on or after February 1, 2017, the Pediatric Symptom Checklist-17 (PSC-17) may be used during a Texas Health Steps (THSteps) checkup when performing the required mental health screening for clients who are 12 through 18 years of age.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
55 (01/20/17 through 02/10/17) *****Attention All CSHCN Services Program Providers*****Effective for dates of service on or after February 1, 2017, the Pediatric Symptom Checklist-17 (PSC-17) may be used when performing the required mental health screening for clients who are 12 through 18 years old.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
56 (01/27/16 through 02/17/17) *****Attention All Medicaid Providers*****Beginning January 13, HHSC will begin using revised criteria for Hepatitis C prior authorization requests. Providers should review the criteria and forms in their entirety prior to submitting prior authorization requests. The Hepatitis C prior authorization criteria apply to all direct-acting antivirals for Hepatitis C for all Medicaid-eligible individuals (both traditional and managed care).Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
57 (01/27/16 through 02/17/17) *****Attention All Medicaid Providers*****HHSC will implement the Agents for gastrointestinal (GI) Motility Clinical Prior Authorization for traditional Medicaid (fee-for-service) on January 18. This prior authorization includes Amitiza, Linzess, Lotronex, Movantik, and Relistor. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
58 (1/20/17 through 2/10/17) *****Attention Medicaid Providers*****Effective for dates of service on or after March 1, 2017, donor human milk may be reimbursed to hospital providers for services rendered to inpatients. Providers may receive reimbursement for the donor human milk service separate from the inpatient Diagnosis-Related Group (DRG) payment.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
59 (1/27/17 through 2/13/17 *****Attention Medicaid Providers*****Effective January 1, 21017 the reimbursement rate for Ambulatory Surgical Center (ASC)/Hospital Ambulatory Surgical Center (HASC) Dental Rehabilitation and Restoration procedure code 41899 will not be reduced, pending further research by the Health and Human Services Commission (HHSC).Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
60 (01/27/17 through 02/17/17) *****Attention All Medicaid Providers*****TMHP will perform scheduled maintenance on Sunday, March 12, 2017, from 4:00 p.m. until 11:59 p.m. All applications and functions will be unavailable during the system maintenance window.For more information, call the TMHP Contact Center at 1-800-925-9126.
61 (1/27/17 through 2/17/17) *****Attention Medicaid Providers*****TMHP has identified an issue that affects Texas Medicaid and Children with Special HealthCare Needs (CSHCN) Services Program laboratory services claims billed with dates of service from May 1, 2015, through January 31, 2017. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
62 (01/27/17 through 02/17/17) *****Attention Medicaid Providers*****Effective February 1, 2017, pregnant state, gestational carrier diagnosis code Z333 will no longer be a benefit of Texas Medicaid.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
63 (02/03/17 through 02/24/17) *****Attention All CSHCN Services Program Providers*****Effective for dates of service on or after February 1, 2017, procedure codes that indicate remote (telemedicine or telehealth) delivery in their description do not need to be billed with the 95 modifier.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
64 (02/03/17 through 02/24/17) *****Attention All Medicaid Providers*****Effective for dates of service on or after February 1, 2017, procedure codes that indicate remote (telemedicine or telehealth) delivery in their description do not need to be billed with the 95 modifier.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
65 (02/03/17 through 02/24/17) *****Attention CSHCN Services Program Providers*****Effective for dates of service on or after January 1, 2017, Physician-Administered Drugs procedure codes J1833 and Q9950 are now benefits of the Children with Special Health Care Needs (CSHCN) Service Program.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
66 (02/03/17 through 02/24/17) *****Attention Medicaid Providers*****The HHSC Inspector General-Utilization Review (IG-UR) Unit has revised the Diagnosis Related Group (DRG) Validation process in compliance with Senate Bill 207, 84th Legislature, Regular Session, 2015. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
67 (02/03/17 through 02/24/17) *****Attention CSHCN Services Program Providers*****Effective for dates of service on or after February 1, 2017, reimbursement rates for some procedure codes for the Children with Special Health Care Needs (CSHCN) Services program will change. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
68 (02/03/17 through 02/24/17) *****Attention Medicaid Providers*****There is an update to an article titled, "Proposed Reimbursement Rate Changes to Be Effective February 1, 2017, Will Be Presented at Public Rate Hearing on December 15, 2016," which was published on the TMHP website on December 5, 2016.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
69 (02/10/17 through 03/03/17) *****Attention CSHCN Services Program Providers*****This is a correction to the January 2017 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin, No. 11. The bulletin indicated that reslizumab procedure code J2786 would be effective for dates of service on or after January 1, 2017. The correct effective date is April 1, 2017. Further, the correct information is that effective for dates of service on or after April 1, 2017, reslizumab procedure code J2786 has been added as a benefit of the Children with Special Health Care Needs (CSHCN) Services Program for monoclonal antibodies for the treatment of asthma and chronic idiopathic urticarial. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
70 (02/10/17 through 03/03/17) *****Attention Medicaid Providers*****This is a correction to the January 2017 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin, No. 11. The bulletin indicated that reslizumab procedure code J2786 would be effective for dates of service on or after January 1, 2017. The proposed effective date is April 1, 2017. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
71 (02/10/17 through 03/03/17) *****Attention Medicaid Providers*****Effective February 1, 2017, for dates of service on or after January 1, 2017, one space maintainer per tooth identification (TID) may be reimbursed per lifetime, per client for Texas Medicaid. Replacement space maintainers may be considered upon appeal with documentation supporting medical necessity. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
72 (02/10/17 through 03/03/17) *****Attention CSHCN Services Program Providers*****Effective February 1, 2017, for dates of service on or after January 1, 2017, one space maintainer per tooth identification (TID) may be reimbursed per lifetime, per client for the Children with Special Health Care Needs (CSHCN) Services Program. Replacement space maintainers may be considered upon appeal with documentation supporting medical necessity. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
73 (02/10/17 through 03/03/17) *****Attention All Medicaid Providers*****Effective immediately, TMHP will begin using revised criteria for prior authorization requests for Medicaid Fee-for-Service (FFS) clients transitioning to a managed care organization (MCO). This only applies for situations in which the requested authorization time period spans across the MCO eligibility or enrollment date for clients transitioning from Medicaid FFS to an MCO. TMHP authorizations will be issued for the time period requested; however providers must submit claims to the MCO for dates covered by the MCO and are not exempt from any of the MCO's prior authorization requirements. The dates covered by the MCO will begin on the date the client became eligible or was enrolled into the MCO.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
74 (02/10/17 through 03/03/17) *****Attention All Medicaid Providers*****Reminder: Genetic testing for colorectal cancer procedure code 81288 requires prior authorization. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
75 (02/17/17 through 03/10/17) *****Attention Medicaid Providers Providers*****Effective for dates of service on or after April 1, 2017, Texas Medicaid benefit criteria will change for mental health targeted case management and mental health rehabilitative services.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
76 (2/17/17 through 3/10/17) *****Attention Medicaid Providers*****This in an update to the article titled "Reimbursement Rate Changes to Be Effective January 1, 2017, Will Be Presented at Public Rate Hearing on January 11, 2017," which was published December 5, 2016 on the tmhp.com website. The correct rate hearing date for the proposed reimbursement rate changes for procedure codes included in the 2017 Annual Healthcare Common Procedure Coding System (HCPCS) was January 12, 2017, and the reimbursement rates are now available.For more information, call the TMHP Contact Center at 1-800-925-9126.
77 (02/17/17 through 03/10/17) *****Attention All Providers*****Effective January 29, 2017, the Centers for Medicare & Medicaid Services (CMS) has extended the moratorium on the enrollment of new home health agency providers and new ground ambulance providers for non-emergency services. CMS has also expanded the moratorium to all counties across the state of Texas. The moratorium is meant to prevent fraud, waste, and abuse.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
78 (02/17/17 through 03/10/17) *****Attention All Medicaid Providers*****Effective for dates of service on or after April 1, 2017, benefit criteria will change for wheelchair accessory, lateral trunk or hip supports, for Texas Medicaid. Implementation of this reimbursement rate is pending; providers will be notified after the rate hearing when a final decision has been made. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
79 (02/17/17 through 03/10/17) *****Attention All Medicaid Providers*****Effective for dates of service on or after March 1, 2017, prior authorization criteria for bath and bathroom equipment will change for Texas Medicaid home health services.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
80 (02/17/17 through 03/10/17) *****Attention Texas Health Steps Dental Providers*****Effective for dates of service on or after April 1, 2017, benefit criteria for diagnostic dental services will change for Texas Medicaid.Details are available on the TMHP website at www.tmhp.com. [link] For more information, call the TMHP Contact Center at 1-800-925-9126.
81 (02/17/17 through 03/10/17) *****Attention All Medicaid Providers*****Clarification: Prior Authorization is required for Breast Cancer Gene 1 and 2 (BRCA) initial testing for Texas Medicaid (procedure codes 81211, 81212, 81214, 81215, 81216, and 81217). Prior Authorization is not required for BRCA large arrangement gene mutation analysis testing (procedure code 812813) when submitted with a negative test result for procedure code 81211.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
82 (2/24/17 through 3/17/17) *****Attention Medicaid and CSHCN Services Program Providers*****This is an update to an article titled "APR-DRG Grouper 34 Will Be Available Effective for Dates of Discharge On or After November 1, 2016," which was published on the TMHP website on October 25, 2016. Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program will use the 2016 3.2 version of Grouper 34 to process inpatient claims effective for dates of discharges on or after October 1, 2016, instead of November 1, 2016.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
83 (02/24/17 through 03/17/17) *****Attention All Medicaid Providers*****On February 17, 2017, HHSC will move the antipsychotic drug Vraylar to non-preferred status and include the drug as part of the Medicaid antipsychotic clinical prior authorization. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
84 (02/24/17 through 03/17/17) *****Attention All Medicaid and CSHCN Services Program Providers*****
On April 1, 2017, TMHP will implement the first quarter 2017 Healthcare Common Procedure Coding System (HCPCS) additions, changes, and deletions, which will be effective for dates of service on or after April 1, 2017. Deleted procedure codes will no longer be benefits of Texas Medicaid or the Children with Special Health Care Needs (CSHCN) Services Program. Reminder: Added procedure codes will not be reimbursed until they are reviewed and a rate hearing is held. Providers will be notified of any changes in benefits in a future article.For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
85 (02/24/17 through 03/17/17) *****Attention All Medicaid Providers*****TMHP has identified an issue with some submitted inpatient and outpatient crossover paper claims that were processed on or after January 2, 2017. An edit was applied during claims processing that required a date indicating that the client was deceased. Affected claims may have been incorrectly denied for date of death.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
86 (02/24/17 through 03/17/17) *****Attention Medicaid Providers*****The HHSC Inspector General-Utilization Review Unit has revised the Diagnosis Related Group Validation process in compliance with Senate Bill 207 84th Legislature (2015). Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
87 (02/24/17 through 03/17/17) *****Attention All CSHCN Services Program Providers*****Effective February 1, 2017, diagnosis code Q234 will be added and may be reimbursed when submitted with procedure code 33619 for repair of a single ventricle aortic outflow obstruction and aortic arch hypoplasia for the Children with Special Health Care Needs (CSHCN) Services Program. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
88 (02/24/17 through 03/17/17) *****Attention Medicaid Providers*****There is a correction to an article titled "Diagnostic Doppler Sonography Diagnosis Codes Benefit Criteria to Change Effective January 1, 2017," which was published on the TMHP website on December 9, 2016.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
89 (02/24/17 through 03/17/17) *****Attention All CSHCN Services Program Providers*****Reminder: Providers must document beginning and end times of outpatient observation services when submitting the Prior Authorization Request for Inpatient Hospital Admission - For Use by Facilities Only form.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
90 (02/24/17 through 03/17/17) *****Attention All Medicaid Providers*****TMHP will perform scheduled system maintenance on Sunday, April 9, 2017, from 4:00 p.m. until 11:59 p.m. All applications and functions will be unavailable during the maintenance window.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
91 (02/24/17 through 03/17/17) *****Attention All Medicaid Providers*****Effective January 13, 2017, for dates of service on or after July 1, 2016, new preventive care visit procedure codes may be reimbursed to federally qualified health centers (FQHCs) for Healthy Texas Women encounters.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
92 (02/24/17 through 03/17/17) *****Attention Texas Health Steps Providers*****The "Mental Health Screening" and "Immunizations Administered" columns in the Texas Health Steps Quick Reference Guide have been updated. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
93 (02/20/17 through 02/24/17) *****Attention All Providers*****Monday, February 20, 2017, is Presidents Day, which is a bank holiday. As a result, electronic funds transfer (EFT) payments will be delayed by one business day. Providers that receive EFT payments can expect funds by Monday, February 27, 2017. For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
94 (03/03/17 through 03/24/17) *****Attention All Medicaid Providers*****HHSC is releasing additional clarification on the information presented in the article titled "Pulse Oximeter Benefit Changes for All Ages Effective March 1, 2017," which was published on the TMHP website on January 4, 2017.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
95 (03/03/17 through 03/24/17) *****Attention All Medicaid Providers*****There is a correction to an article titled "CPAP and RADs, Including Bi-Level PAP Benefit Criteria to Change for Texas Medicaid Effective March 1, 2017," which was published on the TMHP website on January 4, 2017.
Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
96 (03/03/17 through 03/24/17) *****Attention Medicaid Providers*****Effective for dates of services on or after March 1, 2017, and April 1, 2017, proposed reimbursement rate changes were presented at a public rate hearing on February 16, 2017. Implementation of these reimbursement rates is pending; providers will be notified when a final decision has been made.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
97 (03/03/17 through 03/24/17) *****Attention All Medicaid Providers*****Texas Medicaid will implement the Fentanyl Agents clinical prior Authorization on March 7, 2017, for traditional Medicaid clientsDetails are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
98 (03/03/17 through 03/24/17) *****Attention CSHCN Services Program Providers*****TMHP has identified an issue that impacts some paper professional claims submitted on or after January 18, 2017, through February 9, 2017, where provider signature is being considered as invalid.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
99 (03/03/17 through 03/24/17) *****Attention All Medicaid Providers*****TMHP has identified an issue that impacts some paper professional claims submitted on or after January 18, 2017, through February 9, 2017, where provider signature is being considered as invalid.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
100 (03/03/17 through 03/24/17) *****Attention All Medicaid Providers*****There is a correction to an article titled "Oxygen Therapy Benefits to Change for Texas Medicaid March 1, 2017," which was published on the TMHP website on January 4, 2017. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
101 (03/03/17 through 03/24/17) *****Attention All Medicaid Providers*****HHSC is has clarified information about home ventilator with an invasive or noninvasive interface (procedure codes E0465 and E0466) presented in an article titled "Mechanical Ventilation Equipment, Tracheostomy Tubes, and Other Related Supplies Benefit Criteria to Change for Texas Medicaid Effective March 1, 2017," which was published on the TMHP website on January 4, 2017. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
102 (03/03/17 through 03/24/17) *****Attention All Medicaid Providers*****There is a correction to an article titled "New Respiratory Prior Authorization Forms to be Effective March 1, 2017," which was published on the TMHP website on January 4, 2017.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
103 (03/03/17 through 03/24/17) *****Attention All Family Planning Providers*****Effective for dates of service on or after July 1, 2016, procedure code 58562 is a benefit of the Family Planning Program (FPP) for surgical services. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
104 (03/03/17 through 03/24/17) *****Attention All Medicaid Providers*****Effective immediately, TMHP will honor prior authorization requests for NorthSTAR Program behavioral health clients transitioning to Medicaid Fee-for-Service (FFS). Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
105 (03/03/17 through 03/24/17) *****Attention All Medicaid Providers*****The Texas Drug Utilization Review (DUR) Board met January 27, 2017, to make recommendations about clinical prior authorization criteria and which drugs and drug classes to include on the Medicaid Preferred Drug List (PDL). Their recommendations are now available online at the Texas Vendor Drug Program website.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
106 (03/03/17 through 03/24/17) *****Attention All Medicaid Providers*****This is a correction to an article titled, "Clarification: Prior Authorization Required for BRCA Testing," which was published on the TMHP website on February 10, 2017. In the original article, a procedure code for BRCA large arrangement gene mutation analysis was listed incorrectly as 812813.The correct procedure code is 81213. For more information, call the TMHP Contact Center at 1-800-925-9126.
107 (03/03/17 through 03/24/17) *****Attention All Medicaid Providers*****Texas Medicaid is conducting a utilization review of inpatient claims with dates of service from August 19, 2014, through October 27, 2016, to determine whether the claims were paid outside of the spell-of-illness limitation, which is 30 days of inpatient hospital care. Details are available on the TMHP website at www.tmhp.com. [link]
108 (03/03/17 through 03/24/17) *****Attention All Medicaid Providers*****Beginning February 24, 2017, Provider Enrollment on the Portal (PEP) will require providers to select certain fields on the HHSC Medicaid Provider Agreement when submitting an application. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
109 (03/03/17 through 03/24/17) *****Attention All Medicaid Providers*****Reminder: Providers can enter Electronic Visit Verification (EVV) Provider Selection Form (PSF) data into the EVV provider portal, and providers can add, review, and update the data in the portal. Providers can also access the link to the EVV Portal User Guide. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
110 (03/03/17 through 03/24/17) *****Attention All Medicaid Providers*****TMHP has published a reminder to Texas Health Steps (THSteps) providers about the requirements of delegating a THSteps medical checkup to a registered nurse (RN).Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
111 (03/10/17 through 03/31/17) *****Attention CSHCN Services Program Providers*****Effective for dates of service on or after March 1, 2017, reimbursement rates for some procedure codes for the Children with Special Health Care Needs (CSHCN) Services program will change.
Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
112 (03/10/17 through 03/31/17) *****Attention CSHCN Services Program Providers*****There is a correction to the 2017 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin, No. 11. The 2017 HCPCS Procedure Code Additions table incorrectly listed procedure code G0659 with type of service (TOS) 1. The correct TOS is 5. For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
113 (03/10/17 through 03/31/17) *****Attention All Medicaid Providers*****The Health and Human Services Commission (HHSC) has requested that TMHP publish the following information:HHSC has received concerns about a new medication approved by the U.S. Food and Drug Administration (FDA). Spinraza (nusinersen) is an intrathecal injection, approved for the treatment of Spinal Muscular Atrophy (SMA) in pediatric and adult clients. At this time, the Centers for Medicare & Medicaid Services (CMS) has not published a unique procedure code for this medication. Nusinersen will be added to the Medicaid National Drug Code (NDC) crosswalk with a relationship effective date of December 27, 2016.For more information, call the TMHP Contact Center at 1-800-925-9126.
114 (03/10/17 through 03/31/17) *** Attention All Medicaid Providers ***TMHP has published off-cycle static fee schedules to update some outpatient hospital imaging rates. The new fee schedules are available on the TMHP website.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126
115 (03/10/17 through 03/31/17) *****Attention All Medicaid Providers*****There is a correction to the 2017 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin, No. 11. The 2017 HCPCS Procedure Code Additions table incorrectly listed procedure code G0659 with type of service (TOS) 1. The correct TOS is 5. For more information, call the TMHP Contact Center at 1-800-925-9126.
116 (03/10/17 through 03/31/17) *****Attention CSHCN Services Program Providers*****There is a correction to the current Children with Special Health Care Needs Services Program Provider Manual, section 25.2.14, "Urinalysis and Chemistry." This subsection did not list procedure code 83518 as a Clinical Laboratory Improvement Amendments (CLIA) waived test. The subsection has been updated to note procedure code 83518 as a CLIA waived test, which requires modifier QW.Details are available on the TMHP website at www.tmhp.com. [link]
For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
117 (03/17/17 through 04/07/17) *****Attention All Medicaid and CSHCN Services Program Providers*****
Beginning April 1, 2017, the monthly updates to the Texas Medicaid Provider Procedures Manual and the Children with Special Health Care Needs (CSHCN) Services Program Provider Manual will occur at the same time as the implementations for the same month.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
118 (03/17/17 through 04/07/17) *****Attention CSHCN Services Program Providers*****Effective for dates of service on or after March 1, 2017, benefit criteria will change for Respiratory Services for the Children with Special Health Care Needs (CSHCN) Services Program.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
119 (03/17/17 through 04/07/17) *****Attention Medicaid Providers*****The HHSC Inspector General-Utilization Review (IG-UR) Unit has revised the Diagnosis Related Group (DRG) Validation process in compliance with Senate Bill 207, 84th Legislature, Regular Session, 2015. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
120 (03/24/17 through 04/14/17) *****Attention Medicaid Providers*****This is a correction to an article titled "The HHSC Inspector General Utilization Review (IG-UR) Unit Has Revised the DRG Validation Process," which was published on the TMHP website on March 10, 2017.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
121 (03/24/17 through 04/14/17) *****Attention All Medicaid and CSHCN Services Program Providers*****
Effective April 27, 2017, TMHP will add new taxonomy codes associated with allopathic and osteopathic physicians. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
122 (03/24/17 through 04/14/17) *****Attention All Medicaid Providers*****TMHP will perform scheduled system maintenance on Sunday, May 7, 2017, from 4:00 p.m. until 11:59 p.m. All applications and functions will be unavailable during the system maintenance window.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
123 (03/24/17 through 04/13/17) *****Attention Medicaid Providers*****Reminder: Texas Correctional Office of Offenders with Medical or Mental Impairment (TCOOMMI) related services claims with the modifier HZ must be submitted to TMHP and not to the managed care organizations.Effective with dates of service on and after April 1, 2017, TCOOMMI related services claims with the modifier HZ must be submitted to TMHP rather than Medicare-Medicaid Plans (MMPs). All claims with dates of service on or before March 31, 2017, should be submitted to the appropriate MMP.For more information, call the TMHP Contact Center at 1-800-925-9126.
124 (03/24/17 through 04/14/17) *****Attention All Medicaid Providers*****Effective April 28, 2017, claims for acute care services processed by TMHP on or after April 28, 2017, for Texas Medicaid and Medicaid dual-eligible clients enrolled in a Program of All-Inclusive Care for the Elderly (PACE) plan will be denied. PACE is a managed care program, which requires acute care providers rendering services to PACE clients to submit claims to the client's PACE plan. Because PACE is all-inclusive, there are no carved-out benefits separately payable by Texas Medicaid.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
125 (03/24/17 through 04/14/17) *****Attention All Family Planning Program Providers*****Effective May 1, 2017, Family Planning Program (FPP) providers will be able to submit professional claims electronically using a modified CMS-1500 electronic claim form.Provider training materials outlining this functionality will be made available on the TMHP Learning Management System by April 28, 2017.FPP providers must continue to use the 2017 Claim Form when submitting paper claims for family planning services. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
126 (03/24/17 through 04/14/17) *****Attention All Medicaid and Family Planning Program Providers*****
Effective immediately, the Texas Medicaid Electronic Health Record (EHR) Incentive Program has extended the deadline for attesting to receive incentives for Program Year 2016. The new deadline is May 15, 2017. Details are available on the TMHP website at www.tmhp.com [link] or the HHSC Health Information Technology website at healthit.hhsc.texas.gov. For more information, call the TMHP Contact Center at 1-800-925-9126.
127 (03/24/17 through 04/14/17) *****Attention All Medicaid SHARS Providers*****There is a clarification to the article titled, "2017 HCPCS Updates for Texas Medicaid School Health and Related Services Program-Physical and Occupational Therapy," which was published on the TMHP website December 29, 2016.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
128 (04/07/17 through 04/28/17) *****Attention All Medicaid Providers*****TMHP has updated the ASC X12 837P Acute Care Companion Guide. The guide is now available on www.tmhp.com on the Electronic Data Interchange (EDI) home page. The changes allow Family Planning Program (FPP) providers to submit professional claims electronically using a modified CMS-1500 electronic claim form. References to Expanded Primary Health Care (EPHC) have also been removed.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
129 (03/31/17 through 04/21/17) *****Attention All Providers*****This is an update to the article titled "TMHP Scheduled System Maintenance for April 9, 2017," which was posted on the TMHP website at www.tmhp.com on February 17, 2017. The maintenance start time has changed from 4:00 p.m. CDT to 12:00 p.m. CDT. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
130 (03/31/17 through 04/21/17) *****Attention Medicaid Providers*****This is an update to an article titled, "Proposed Reimbursement Rates Changes and Updates for Texas Medicaid to Be Effective March 1, 2017 and April 1, 2017," which was published on the TMHP website on February 23, 2017.Details are available on the TMHP website at www.tmhp.com. [link]
For more information, call the TMHP Contact Center at 1-800-925-9126
131 (03/31/17 through 04/21/17) *****Attention All Providers*****TMHP will perform extended system maintenance from 7 p.m. Friday, April 28, 2017, until 11:59 p.m. Sunday, April 30, 2017. All applications and functions will be unavailable during the system maintenance window. For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
132 (03/31/17 through 04/21/17) *****Attention All Medicaid Providers*****On March 25, 2017, the Alprazolam/Carisoprodol/Hydrocodone Combination clinical prior authorization criteria will be replaced with the Opiate/Benzodiazepine/Muscle Relaxant Clinical prior authorization for traditional Medicaid clients. The new criteria were reviewed and approved by the Texas Drug Utilization Review Board in July 2016.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
133 (03/31/17 through 04/21/17) *****Attention CSHCN Services Program Providers*****Effective for dates of service on or after April 1, 2017, reimbursement rates for some procedure codes for the Children with Special Health Care Needs (CSHCN) Services program will change. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
134 (04/07/17 through 04/28/17) *****Attention All Texas Health Steps Providers*****The Mental Health Screening column in the Texas Health Steps Quick Reference Guide has been updated. The Pediatric Symptom Checklist (PSC-17) was added to the list of approved mental health screening tools. The updated document is available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
135 (04/07/17 through 04/28/17) *****Attention CSHCN Services Program Providers*****Effective for dates of service on or after March 1, 2017, reimbursement rates for some Respiratory Equipment and Supplies procedure codes for the Children with Special Health Care Needs (CSHCN) Services program were changed. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
136 (04/07/17 through 04/28/17) *****Attention All CSHCN Services Program Providers*****Effective for dates of service on or after April 1, 2017, benefit criteria for diagnostic dental services will change for Texas Medicaid.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
137 04/07/17 through 04/28/17 *****Attention All Medicaid Providers*****On April 26, 2017, TMHP will conduct a live webinar designed to offer a high-level introduction to Medicaid Basics. The webinar will include additional related state program information with the intent to support the provider's role and responsibilities. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
138 (04/07/17 through 04/28/17) *****Attention All FQHC Providers*****Effective for dates of service on or after December 2, 2016, preventive care visit procedure codes are no longer limited to three encounter payments per Healthy Texas Women (HTW) client per year for federally qualified health centers (FQHCs).Note: FQHCs may be reimbursed for three family planning encounters per year, per HTW client.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
139 (04/07/17 through 04/28/17) *****Attention All Medicaid Providers*****Starting April 1, 2017, eligible professionals (EPs) participating in the Medicaid Electronic Health Record (EHR) Incentive Program for Program Year 2017 or later must complete a Third Party Attestation Authorization Form to designate the person who will be attesting on their behalf for EHR incentives. The form allows an EP to authorize a third party to complete the EP's attestation for incentives and to receive notice or communication in connection with the provider's attestation. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
140 (04/14/17 through 05/05/17) *****Attention All Medicaid Providers*****TMHP will implement first quarter additions to the 2017 Healthcare Common Procedure Coding System (HCPCS) on April 1, 2017.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
141 (4/14/17 through 05/05/17) *****Attention CSHCN Services Program Providers*****Effective April 6, 2017, the Children with Special Health Care Needs (CSHCN) Services Program reimbursement rates for some 2017 Healthcare Common Procedure Coding System (HCPCS) procedure codes will implement for dates of service on or after January 1, 2017. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
142 (04/14/17 through 05/05/17) *****Attention All Medicaid and CHSCN Services Program Providers*****
The 2016-2017 Respiratory Syncytial Virus (RSV) season will end on April 14, 2017, for all counties in Texas. The Vendor Drug Program (VDP) will end coverage of Synagis (Palivizumab) effective April 14, and pharmacy claims or prior authorizations will not be accepted or reviewed after April 14. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
143 (04/14/17 through 05/05/17) *****Attention All CSHCN Services Program Providers*****TMHP will implement first quarter additions to the 2017 Healthcare Common Procedure Coding System (HCPCS) on April 1, 2017.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
144 (4/14/17 through 05/05/17) *****Attention CSHCN Services Program Providers*****Effective April 6, 2017, the Children with Special Health Care Needs (CSHCN) Services Program reimbursement rates for some 2017 Healthcare Common Procedure Coding System (HCPCS) procedure codes will implement for dates of service on or after January 1, 2017. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
145 (04/21/17 through 05/12/17) *****Attention All Providers*****TMHP will perform extended system maintenance from 7:00 p.m., Friday, June 23, 2017, until 11:59 p.m., Sunday, June 25, 2017. All applications and functions will be unavailable during the system maintenance window. For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
146 (04/22/17 through 05/06/17) *****Attention All Medicaid Providers*****The Medicaid/Children's Health Insurance Program (CHIP) division of the Health and Human Services Commission (HHSC) is asking for provider feedback on the automation of the Utilization Review Medical Appeals process. Beginning April 14, 2017, providers can complete a short, online survey. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
147 (04/21/17 through 05/12/17) *****Attention All Medicaid Providers*****Effective for dates of service on or after June 1, 2017, telemedicine benefits will change for Texas Medicaid.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
(04/21/17 through 05/12/17) *****Attention All Medicaid Providers*****Effective for dates of service on or after June 1, 2017, telehealth benefits will change for Texas Medicaid.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
148 (04/28/17 through 05/19/17) *****Attention All Medicaid Providers*****There is a correction to an article titled "Benefit Criteria to Change for Respiratory Equipment and Supplies Effective March 1, 2017," which was published on the TMHP website on January 3, 2017.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
149 (04/28/17 through 05/19/17) *****Attention Medicaid Providers*****Effective for dates of services on or after May 1, 2017, procedure code 92621 will be payable for audiologists for services rendered in an office setting to Texas Medicaid clients.For more information, call the TMHP Contact Center at 1-800-925-9126.
150 (04/28/17 through 05/19/17) *****Attention All Medicaid Providers*****TMHP will perform scheduled system maintenance on Sunday, May 7, 2017, from 4:00 p.m. until 11:59 p.m. All applications and functions will be unavailable during the maintenance window.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
151 (04/28/17 through 05/19/17) *****Attention All Medicaid Providers*****The agenda for the April 28, 2017, Texas Drug Utilization Review Board meeting is now available.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
152 (04/28/17 through 05/19/17) *****Attention All Providers*****The Texas Department of State Health Services (DSHS) is modifying Zika Testing Criteria for Residents of the Lower Rio Grande Valley.Testing is recommended as part of routine prenatal care for pregnant residents of Cameron, Hidalgo, Starr, Webb, Willacy, and Zapata counties, and for residents of those counties who exhibit a rash and at least one other common Zika symptom. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
153 (04/28/17 through 05/19/17) *****Attention All CSHCN Services Program Providers*****There is a correction to an article titled "Benefit Criteria to Change for CSHCN Respiratory Services Effective March 1, 2017," which was published on the TMHP website on March 9, 2017.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
154 (05/12/17 through 06/02/17) *****Attention Medicaid Providers*****The HHSC Inspector General-Utilization Review (IG-UR) Unit has revised the Diagnosis Related Group (DRG) validation process in compliance with Senate Bill 207 84th Legislature (2015). Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
155 (05/05/17 through 05/26/17) *****Attention All CSHCN Services Program Providers*****Effective for dates of service on or after June 1, 2017, telemedicine and telehealth benefits will change for the Children with Special Health Care Needs (CSHCN) Services Program.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
156 (05/05/17 through 05/26/17) *****Attention All Medicaid Providers*****HHSC will implement the Nuedexta clinical prior authorization for individuals enrolled in traditional Medicaid on May 2, 2017. This prior authorization was approved by the Texas Drug Utilization Review Board on January 27, 2017. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
157 (05/12/17 through 06/02/17) *****Attention Medicaid Providers*****Effective for dates of service on or after June 1, 2017, the reimbursement rates for Prescribed Pediatric Extended Care Centers presented at a public rate hearing on November 14, 2016, will become payable. The rates are available for viewing online at the HHSC rate analysis web page at legacy-hhsc.hhsc.state.tx.us/rad/rate-packets.shtml.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126
158 (05/12/17 through 06/02/17) *****Attention Medicaid Providers*****Effective for dates of services on or after July 1, 2017, proposed reimbursement rate changes will be presented at a public rate hearing on May 18, 2017. Implementation of these reimbursement rates is pending. Providers will be notified when a final decision has been made.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
159 (05/12/17 through 06/02/17) *****Attention All Medicaid and CSHCN Services Program Providers*****
Effective for dates of service on or after May 5, 2017, laboratory providers must include modifier U4 with procedure code 86790, 87798, or 87799 when submitting a claim for Zika virus testing. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
160 (05/19/17 through 06/09/17) *****Attention All Family Planning Program Providers*****Family Planning Program (FPP) providers can now submit professional claims electronically using a modified CMS-1500 electronic claim.A training snapshot and a job aid describing this functionality are available on the TMHP Learning Management System (LMS) at learn.tmhp.com.Details are available on the TMHP website at www.tmhp.com. [link]
For more information, call the TMHP Contact Center at 1-800-925-9126.
161 (05/19/17 through 06/09/17) *****Attention Medicaid Providers*****This is a correction to an article titled "Reimbursement Rate Updates for Prescribed Pediatric Extended Care Center Effective June 1, 2017," which was published on the TMHP website on May 1, 2017. The article incorrectly listed procedure code T2022 instead of the correct procedure code T2002.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
162 (05/19/17 through 06/09/17) *****Attention All Medicaid and CSHCN Services Program Providers*****
On April 30, 2017, the second quarter 2017 National Correct Coding Initiative (NCCI) updates were implemented for claims processed by TMHP for Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
163 (05/19/17 through 06/09/17) *****Attention All CSHCN Services Program Providers*****On July 1, 2017, TMHP will implement the second quarter 2017 Healthcare Common Procedure Coding System (HCPCS) additions, changes, and deletions, which will be effective for dates of service on or after July 1, 2017. Deleted procedure codes will no longer be considered benefits of the Children with Special Health Care Needs (CSHCN) Services Program. Reminder: Added procedure codes will not be reimbursed until they are reviewed and a rate hearing is held. Providers will be notified in a future article of any changes in benefits.For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
164 (05/19/17 through 06/09/17) *****Attention All Medicaid and CSHCN Services Program Providers*****
There is a correction to All Patient Refined Diagnosis Related Group Grouper 34, which was effective for inpatient hospital claims with discharge dates on or after October 1, 2016. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
165 (05/19/17 through 06/09/17) *****Attention Medicaid Providers*****Effective for dates of service on or after July 1, 2017, psychological, neurobehavioral and neuropsychological testing benefits will be updated for Texas Medicaid. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
166 (05/19/17 through 06/09/17) *****Attention All Medicaid Providers*****On July 1, 2017, TMHP will implement the second quarter 2017 Healthcare Common Procedure Coding System (HCPCS) additions, changes, and deletions, which will be effective for dates of service on or after July 1, 2017. Deleted procedure codes will no longer be considered benefits of Texas Medicaid. Added procedure codes will not be reimbursed until they are reviewed and a rate hearing is held. Providers will be notified in a future article of any changes in benefits.For clinician administered drug procedure codes included in a quarterly HCPCS update and approved to be added as Medicaid benefits by HHSC, the rate may be effective as of the CMS effective date. For more information, call the TMHP Contact Center at 1-800-925-9126.
167 (05/26/17 through 06/16/17) *****Attention All Medicaid Providers*****Effective May 16, 2017, claims submitted with a date of service on or after October 15, 2015 with diagnosis Z01110 may be reimbursed. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
168 (05/19/17 through 06/09/17) *****Attention CSHCN Services Program Providers*****Effective for dates of service on or after July 1, 2017, benefit criteria for behavioral health services will change for the Children with Special Health Care Needs (CSHCN) Services Program. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
169 (05/19/17 through 06/09/17) *****Attention Medicaid Providers*****On June 1, 2017, hospitals will gain access to their fiscal year (SFY) 2016 hospital-level Potentially Preventable Readmissions (PPR) and Potentially Preventable Complications (PPC) reports. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
170 (05/26/17 through 06/16/17) *****Attention All Medicaid Providers*****This is an update to the article titled "Claims for Acute Care Services Rendered to Medicaid and Medicaid Dual-Eligible Clients Who are Enrolled in PACE to Deny, Effective April 28, 2017," which was posted on this website on March 17, 2017. Claims submitted for Program of All-Inclusive Care for the Elderly (PACE) clients on or after May 1, 2015, may have been paid erroneously by Medicaid rather than being referred to the appropriate PACE plan.
171 (05/26/17 through 06/16/17) *****Attention All Medicaid Providers*****Effective for dates of service on or after July 1, 2017, Texas Health Steps (THSteps) therapeutic dental benefits will change for Texas Medicaid.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
172 (05/26/17 through 06/02/17) *****Attention All Providers*****Memorial Day, May 29, is a bank holiday. As a result, electronic funds transfer (EFT) payments will be delayed one business day. Providers that receive EFT payments can expect funds by Monday, June 5. For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
173 (06/02/17 through 06/23/17) *****Attention All CSHCN Services Program Providers*****Effective for dates of service on or after June 1, 2017, updated reimbursement rates for Prescribed Pediatric Extended Care Centers (PPECC) will become effective for the Children with Special Health Care Needs (CSHCN) Services Program. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
174 (06/02/17 through 06/23/17) *****Attention CSHCN Services Program Providers*****Effective for dates of service on or after June 1, 2017, reimbursement rates for some procedure codes for the Children with Special Health Care Needs (CSHCN) Services program will change. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
175 (06/02/17 through 06/23/17) *****Attention Medicaid Providers*****There is a follow up to an article titled "First Quarter 2017 HCPCS Updates," which was published on the TMHP website on April 5, 2017.Details are available on the TMHP website at www.tmhp.com. [link]
For more information, call the TMHP Contact Center at 1-800-925-9126.
176 (06/02/17 through 06/23/17) *****Attention All Providers*****The Texas Medicaid excluded providers list for May 2017 has been published. Providers may refer to the Texas Medicaid Excluded Providers web page on the TMHP website for the list.The complete Texas Medicaid exclusion list is available on the HHSC Office of Inspector General (OIG) website.For more information, call the TMHP Contact Center at 1-800-925-9126.
177 (05/19/17 through 07/10/17) *****Attention All Medicaid Providers*****TMHP will perform scheduled system maintenance on Sunday, July 9, 2017, from 4:00 p.m. until 11:59 p.m. All applications and functions will be unavailable during the system maintenance window.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
178 (05/22/17 through 06/09/17) *****Attention All Medicaid Providers*****Federal law and regulation require states to screen and enroll all Children's Health Insurance Program (CHIP) providers by December 31, 2017. To meet this requirement, current CHIP providers must be actively enrolled with the Texas Medicaid & Healthcare Partnership (TMHP) by December 31, 2017. While CHIP providers must enroll with TMHP to continue to receive reimbursement for CHIP services, CHIP-only providers are not required to participate in Texas Medicaid. Providers must indicate in the application that they intend only to serve CHIP members to ensure they do not appear on the Medicaid online provider lookup (OPL).Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
179 (05/26/17 through 06/16/17) *****Attention All Medicaid Providers*****The Texas Drug Utilization Review Board held its quarterly meeting on April 28, 2017, to make recommendations for the Texas Medicaid program's clinical prior authorizations and preferred drug list (PDL). A summary of the April board meeting is available at the Vendor Drug Program website. The next board meeting is scheduled for Friday, July 28, 2017.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
180 (06/02/17 through 06/23/17) *****Attention Family Planning Program Providers*****TMHP has identified an issue that affects claims submitted with dates of service August 1, 2016, through April 25, 2017, with vaccination procedure codes 90660 and 90710 for Federally Qualified Health Centers (FQHC) providers. These claims may have been processed incorrectly. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
181 (06/02/17 through 06/23/17) *****Attention All Medicaid Providers*****TMHP has posted a reminder to providers enrolled as a tuberculosis (TB) clinic about billing laboratory handling fee for TB specimens transported to a laboratory.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
182 (06/09/17 through 06/30/17) *****Attention Medicaid Providers*****The HHSC Inspector General-Utilization Review (IG-UR) Unit has revised the Diagnosis Related Group (DRG) Validation process in compliance with Senate Bill 207 84th Legislature (2015). Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
183 (06/09/17 through 06/30/17) *****Attention All Medicaid Providers*****There is an update to the article titled, "THSteps Therapeutic Dental Benefits to Change for Texas Medicaid July 1, 2017," which was published on the TMHP website May 17, 2017.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
184 (06/09/17 through 06/30/17) *****Attention All Texas Medicaid Providers*****There is a correction to an article titled "Reminder: Allergy Testing Benefits for Texas Medicaid," which was published on the TMHP website on Dec. 23, 2016.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
185 (06/09/17 through 06/30/17) *****Attention Medicaid Providers*****For services rendered to clients who are dual-eligible for Texas Medicaid and Medicare, some procedure codes have been updated to be Medicaid-only and are not required to be submitted to Medicare before they are submitted to Medicaid.
Details are available on the TMHP website at www.tmhp.com. [link] For more information, call the TMHP Contact Center at 1-800-925-9126
186 (06/09/17 through 06/30/17) *****Attention All Medicaid Providers*****As part of Federal Regulation (Code of Federal Regulations 455.432), TMHP may conduct a scheduled or unscheduled post-enrollment site visit for providers who are designated as "moderate" or "high" risk. The purpose of a post-enrollment site visit is to verify that providers are in compliance with federal and state enrollment requirements. Failure to comply may result in denial and or termination of a provider's Medicaid contract. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
187 (06/09/17 through 06/30/17) *****Attention All Medicaid Providers*****Effective July 27, 2017, Texas Medicaid will implement the semi-annual update of the Medicaid Preferred Drug List (PDL). The update is based on changes presented at the Drug Utilization Review (DUR) Board meetings in January and April 2017.Details are available on the TMHP website at www.tmhp.com. [link] For more information, call the TMHP Contact Center at 1-800-925-9126.
188 (06/16/17 through 07/07/17) *****Attention All CSHCN Services Program Providers*****Effective for dates of service on or after July 1, 2017, therapeutic dental benefits will change for the Children with Special Health Care Needs (CSHCN) Services Program.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
189 (06/23/17 through 07/14/17) *****Attention All CSHCN Services Program Providers*****Effective for dates of service on or after August 1, 2017, the age limitation for influenza vaccine procedure codes 90686 and 90688 will be expanded for the Children with Special Health Care Needs (CSHCN) Services Program.Details are available on the TMHP website at www.tmhp.com. [link] For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
190 (06/23/17 and 07/14/17) *****Attention All Medicaid Providers*****The 2017 Medicaid Basics webinar that was conducted on April 26, 2017, is now available as a recording on the TMHP Learning Management System (LMS) website.Details are available on the TMHP website at www.tmhp.com. [link]
For more information, call the TMHP Contact Center at 1-800-925-9126.
191 (06/23/17 through 07/14/17) *****Attention All Medicaid Providers*****Effective for dates of service on or after August 1, 2017, the age limitation for influenza vaccine procedure codes 90686 and 90688 will be expanded for Texas Medicaid.Details are available on the TMHP website at www.tmhp.com. [link] For more information, call the TMHP Contact Center at 1-800-925-9126.
192 (06/30/17 through 07/21/17) *****Attention All Medicaid Providers*****Texas Medicaid is conducting a utilization review of inpatient claims with dates of service from July 17, 2015, through April 28, 2017, to determine whether the claims were paid outside of the spell-of-illness limitation, which is 30 days of inpatient hospital care. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
193 (06/23/17 through 08/13/17) *****Attention All Medicaid Providers*****TMHP will perform scheduled system maintenance on Aug. 13 from 4 p.m. until 11:59 p.m. All applications and functions will be unavailable during the system maintenance window.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
194 (06/30/17 through 07/21/17) *****Attention All Medicaid Providers*****Effective May 2, 2017, some procedure codes must be submitted to Medicare before they are submitted to Medicaid for consideration of reimbursement for services rendered to dual-eligible clients. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
195 (06/30/17 through 07/21/17) *****Attention All Providers*****Tuesday, July 4, 2017, is Independence Day, which is a bank holiday. As a result, electronic funds transfer (EFT) payments will be delayed by one business day. Providers that receive EFT payments can expect funds by Monday, July 10, 2017. For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
196 (06/30/17 through 07/21/17) *****Attention All Medicaid Providers*****Effective for dates of service on or after August 1, 2017, benefit guidelines for pharmacogenetics will change for Texas Medicaid.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
197 (07/07/17 through 07/28/17) *****Attention All Medicaid and CSHCN Services Program Providers*****
On July 29, 2017, the third quarter 2017 National Correct Coding Initiative (NCCI) updates will be implemented for claims processed by TMHP for Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
198 (07/07/17 through 07/28/17) *****Attention All Medicaid and CSHCN Services Program Providers*****
Effective June 23, 2017, TMHP will begin accepting and processing national place of service (POS) code 02 on paper and electronic claims.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
199 (07/07/17 through 07/28/17) *****Attention All Medicaid and CSHCN Services Program Providers*****
This is a reminder to providers to use the most appropriate fax communication telephone numbers when submitting requests to TMHP.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
200 (07/07/17 through 07/28/17) *****Attention Medicaid Providers*****This is an update to an article titled "Proposed Reimbursement Rate Changes for Texas Medicaid to Be Effective July 1, 2017," which was published on the TMHP website on May 2, 2017.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
201 (07/07/17 through 07/28/17) *****Attention All Medicaid and CSHCN Services Program Providers*****
The Ordering, Referring, and Prescribing Providers (ORPs) Frequently Asked Questions (FAQ) document is now available on the TMHP website.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
202 (07/07/17 through 07/28/17) *****Attention All Medicaid Providers*****Effective for dates of service on or after September 1, 2017, physical, occupational, and speech therapy benefits for all ages will change for Texas Medicaid.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
203 (07/14/17 through 08/04/17) *****Attention All Healthy Texas Women Providers*****There is a correction to the current Texas Medicaid Provider Procedures Manual, Women's Health Services Handbook, subsection 2.3, "Services, Benefits, Limitations, and Prior Authorization." Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
204 (07/14/17 through 08/04/17) *****Attention All Medicaid Providers*****Beginning July 28, 2017, the TMHP Automated Inquiry System (AIS), the Electronic Data Interchange (EDI), and the Online Provider Lookup (OPL) will be updated to reflect the name change that occurred December 1, 2016, from Seton Health Plan (SHP) Managed Care Organization to Dell Children's Health Plan.For more information, call the TMHP Contact Center at 1-800-925-9126.
205 (07/14/17 through 08/04/17) *****Attention All Medicaid Providers*****Effective August 1, 2017, the total and technical components of some radiological procedure codes will become payable for portable x-ray suppliers and radiological and physiological laboratories for Texas Medicaid services rendered in an office setting.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
206 (07/21/17 through 08/11/17) *****Attention All Medicaid Providers*****HHSC is currently approving prior authorizations for providers for the full duration requested, even when the prior authorizations extend beyond a provider's enrollment revalidation deadline. Providers with approved authorizations who do not revalidate their Texas Medicaid enrollment in a timely manner will not be paid for claims with dates of service that are past their revalidation deadline.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
207 (07/21/17 through 08/11/17) *****Attention All Medicaid Providers*****The Patient Protection and Affordable Care Act (PPACA) requires states to screen and enroll all Children's Health Insurance Program (CHIP) providers by December 31, 2017. CHIP providers must submit applications as soon as possible to ensure that the Texas Medicaid enrollment process is complete by December 31, 2017. Providers may submit applications electronically using Provider Enrollment on the Portal (PEP) or the paper application. Electronic submission is encouraged to facilitate timely receipt and processing.The Texas Medicaid Provider Enrollment Application, PEP, and Provider Information Management System (PIMS) have been updated to reflect changes related to CHIP enrollment. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
208 (07/21/17 through 08/11/17) *****Attention All Medicaid Providers*****Effective for dates of service on or after August 1, 2017, prior authorization criteria will change for injection procedure code C9484 for Texas Medicaid.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
209 (07/21/17 through 08/11/17) *****Attention All Providers*****Effective May 30, 2017, for dates of service on or after July 1, 2016, procedure code T1015 may be reimbursed to rural health clinic providers for services provided through the Healthy Texas Women program.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
210 (07/28/17 through 08/18/17) *****Attention All CSHCN Services Program Providers*****Effective for dates of service on or after September 1, 2017, procedure code 97542 will become a benefit for seating assessments for the Children with Special Health Care Needs (CSHCN) Services Program. Details are available on the TMHP website at www.tmhp.com. [link]
For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
211 (07/28/17 through 08/18/17) *****Attention ECI Providers*****Effective for dates of service on or after September 1, 2017, Early Childhood Intervention (ECI) Services Comprehensive Care Program (CCP) benefits will be updated for Texas Medicaid.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
212 (07/28/17 through 08/18/17) *****Attention MTP Providers*****Effective September 1, 2017, LogistiCare Solutions LLC, will begin providing nonemergency medical transportation (NEMT) services in Managed Transportation Organization (MTO) Regions 1 and 10.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call MTP at 1-855-435-7182.
213 (07/28/17 through 08/18/17) *****Attention All CSHCN Services Program Providers*****Effective immediately, the Children with Special Health Care Needs (CSHCN) Services Program telephone appeal process for claims corrections is available.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
214 (07/21/17 through 09/17/17) *****Attention All Medicaid Providers*****TMHP will perform scheduled system maintenance on Sept. 10 from 4 p.m. until 11:59 p.m. All applications and functions will be unavailable during the maintenance window.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
215 (07/28/17 through 08/18/17) *****Attention All Medicaid Providers*****The Vendor Drug Program drug shortage notification process is available for pharmacy staff to report significant drug shortages that could affect multiple pharmacies and distributors and may have continuing adverse impact on Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program population if not resolved in a timely manner. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
216 (07/28/17 through 08/18/17) *****Attention All Medicaid Providers*****The agenda for the July 28, 2017, Texas Drug Utilization Review Board meeting is now available online.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
217 (07/28/17 through 08/18/17) *****Attention All Medicaid Providers*****There is a clarification to the article titled, "Payable Ages for Influenza Vaccine Procedure Codes 90686 and 90688 to be expanded August 1, 2017, for Texas Medicaid," which was published on the TMHP website June 16, 2017.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
218 (08/04/17 through 08/25/17) *****Attention All Medicaid Providers*****The July 2017 Texas NDC to HCPCS Crosswalk is now available for clinician-administered drug (CAD) processing. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
219 (08/04/17 through 08/25/17) *****Attention All Medicaid Providers*****Effective for dates of service on or after September 1, 2017, breastfeeding support services will change for Texas Medicaid.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
220 (08/4/17 through 08/25/17) *****Attention Texas Health Steps Providers*****Some links to web pages have been updated on the Texas Health Steps Quick Reference Guide. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
221 (08/04/17 through 08/25/17) *****Attention All Medicaid Providers*****Beginning May 18, 2017, TMHP added hospital providers as a payable provider type for procedure code J9354 when services are provided in the outpatient hospital setting. Previously denied claims for hospital providers, provided in an outpatient setting, that include procedure code J9354, will be reprocessed for dates of service from May 18, 2015, through May 18, 2017, and providers may receive additional payment, which will be reflected on future Remittance and Status (R&S) Reports.
For more information, call the TMHP Contact Center at 1-800-925-9126.
222 (08/04/17 through 08/25/17) *****Attention All Medicaid Providers*****Upon request, hospital providers are required to provide a complete medical record to the Texas Health and Human Services Commission (HHSC) Inspector General (IG) Utilization Review (UR) to conduct inpatient hospital Medicaid claim utilization reviews.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
223 (08/04/17 through 08/25/17) *****Attention All Medicaid Providers*****Effective July 1, 2017, automated test panel (ATP) pricing rates changed in accordance with the Centers for Medicare and Medicaid Services (CMS) clinical laboratory fee schedule, which is available on the CMS website. Claims submitted with dates of service from July 1, 2017, through July 21, 2017, and with affected ATPs will be reprocessed. Providers may receive an adjusted payment, which will be reflected on future Remittance and Status (R&S) Reports. For more information, call the TMHP Contact Center at 1-800-925-9126.
224 (08/04/17 through 08/25/17) *****Attention Medicaid Providers*****Effective for dates of services on or after July 1, 2017 and October 1, 2017, proposed reimbursement rate changes will be presented at a public rate hearing on August 8, 2017. Implementation of these reimbursement rates is pending. Providers will be notified when a final decision has been made.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
225 (06/23/17 through 08/25/17) *****Attention All Medicaid Providers*****This is an update to the article titled, "The Expanded Primary Health Care (EPHC) Program and the Family Planning Program Wrap-Around Coverage Will be Discontinued Effective July 1, 2016," which was published on May 13, 2016, on www.tmhp.com. All references to EPHC will be removed from the TMHP website, the Texas Medicaid Provider Procedures Manual, provider forms, and all other applicable locations where EPHC was mentioned, except for the Fee Schedules. The Fee Schedules will continue to display EPHC references for historical purposes.For more information, call the TMHP Contact Center at 1-800-925-9126.
226 (08/11/17 through 09/01/17) *****Attention All Medicaid and CSHCN Services Program Providers*****
Genentech has notified the Vendor Drug Program (VDP) of National Drug Code (NDC) changes for the drugs Herceptin and Lucentis. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
227 (08/04/17 through 08/25/17) *****Attention All Medicaid Providers*****On June 29, 2017, TMHP implemented the second quarter 2017 Healthcare Common Procedure Coding System (HCPCS) additions, revisions and discontinuations, which will be effective for dates of service on or after July 1, 2017. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
228 (08/11/17 through 09/01/17) *****Attention All Medicaid Providers*****Procedure code J1725 is required when submitting claims for Hydroxyprogesterone Caproate injection to Texas Medicaid.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
229 (08/11/17 through 09/01/17) *****Attention CSHCN Services Program Providers*****Effective for dates of service on or after August 1, 2017, reimbursement rates for some procedure codes for the Children with Special Health Care Needs (CSHCN) Services program will change. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
230 (08/11/17 through 09/01/17) *****Attention All CSHCN Services Program Providers*****On June 29, 2017, TMHP implemented second quarter 2017 Healthcare Common Procedure Coding System (HCPCS) additions, revisions and discontinuations, which were effective for dates of service on or after July 1, 2017.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
231 (08/18/17 through 09/08/17) *****Attention CSHCN Services Program Providers*****Effective for dates of service on or after October 1, 2017, some laboratory procedure codes type of service benefits will change for the Children with Special Health Care Needs (CSHCN) Services Program. Details are available on the TMHP website at www.tmhp.com. [link]
232 (08/18/17 through 09/08/17) *****Attention All Medicaid and CSHCN Services Program Providers*****
Beginning August 15, 2017, the Vendor Drug Program (VDP) will enhance the restriction on the use of products containing tramadol and codeine for those enrolled in Medicaid fee-for-service and the Children with Special Healthcare Needs (CSHCN) Services Program. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
233 (08/18/17 through 09/08/17) *****Attention Medicaid Providers*****Effective for dates of service on or after July 1, 2017, human immunodeficiency virus (HIV) testing procedure code G0433 will become a benefit for Texas Medicaid.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
234 (08/18/17 through 09/07/17) *****Attention Medicaid Providers*****Effective for dates of service on or after October 1, 2017, chemotherapy procedure code G0498 will become a benefit for Texas Medicaid.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
235 (08/18/17 through 09/08/17) *****Attention All Medicaid Providers*****Effective for dates of service on or after October 1, 2017, benefits for blood factor products will change for Texas Medicaid.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
236 (08/18/17 through 09/08/17) *****Attention All Medicaid Providers*****Effective for dates of service on or after October 1, 2017, infliximab procedure code Q5102 will be a benefit for Texas Medicaid.Details are available on the TMHP website at www.tmhp.com. [link]
For more information, call the TMHP Contact Center at 1-800-925-9126.
237 (08/18/17 through 09/08/17) *****Attention All Medicaid Providers*****Effective for dates of service on or after October 1, 2017, procedure codes J7301 and J7307 will be payable for family planning clinics for services rendered in an outpatient hospital setting for Texas Medicaid. For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
238 (08/18/17 through 09/08/17) *****Attention All Providers*****Effective July 29, 2017, the Centers for Medicare & Medicaid Services (CMS) extended the moratorium on the enrollment of new home health agency providers and new ground ambulance providers for non-emergency services and expanded the moratorium to all counties across the state of Texas. The moratorium is meant to prevent fraud, waste and abuse.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
239 (08/18/17 through 09/15/17) *****Attention Medicaid Providers*****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. Billing structure will no longer be based on provider type. Billing structure for therapy procedures codes will align across provider types and will be based on the procedure code billed. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
240 (08/18/17 through 09/15/17) *****Attention All Medicaid Providers*****Texas is currently preparing for its next Payment Error Rate Measurement (PERM) review, which will cover Medicaid and Children's Health Insurance Program (CHIP) claims paid during federal fiscal year 2017 (October 1, 2016, to September 30, 2017).Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
241 (08/18/17 through 09/08/17) *****Attention CSHCN Services Program Providers*****Effective for dates of service on or after September 1, 2017, physical, occupational, and speech therapy requests for prior authorization will change for the Children with Special Health Care Needs (CSHCN) Services Program. Billing structure for therapy procedures codes will align across provider types and will be based on the procedure code billed. Details are available on the TMHP website at www.tmhp.com. [link]
For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
242 (08/18/17 through 09/08/17) *****Attention All Medicaid Providers*****Effective for dates of service on or after October 1, 2017, magnetoencephalography benefits will change for Texas Medicaid.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
243 (08/18/17 through 09/08/17) *****Attention All CSHCN Services Program Providers*****Effective for dates of service on or after October 1, 2017, magnetoencephalography benefits will change for the Children with Special Health Care Needs (CSHCN) Services Program.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
244 (08/18/17 through 09/08/17) *****Attention All Medicaid Providers*****On October 1, 2017, TMHP will implement the third quarter 2017 Healthcare Common Procedure Coding System (HCPCS) additions, revisions and discontinuations, which will be effective for dates of service on or after October 1, 2017. Discontinued procedure codes will no longer be considered benefits of Texas Medicaid. Added procedure codes will not be reimbursed until the codes are reviewed and a rate hearing is held. Providers will be notified in a future article of any further changes in benefits.The rate may be effective as of the CMS effective date for clinician administered drug procedure codes included in a quarterly HCPCS update and approved to be added as Medicaid benefits by HHSC. For more information, call the TMHP Contact Center at 1-800-925-9126.
245 (08/18/17 through 09/08/17) *****Attention All CSHCN Services Program Providers*****On October 1, 2017, TMHP will implement the third quarter 2017 Healthcare Common Procedure Coding System (HCPCS) additions, revisions and discontinuations, which will be effective for dates of service on or after October 1, 2017. Discontinued procedure codes will no longer be considered as benefits of the Children with Special Health Care Needs (CSHCN) Services Program. Added procedure codes will not be reimbursed until the codes are reviewed and a rate hearing is held. Providers will be notified in a future article of any changes in benefits.For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
246 (08/25/17 through 09/15/17) *****Attention All Medicaid Providers*****The August 2017 Texas National Drug Code (NDC) to Healthcare Common Procedure Coding System (HCPCS) Crosswalk Crosswalk is now available for clinician-administered drug (CAD) processing. Details are available on the TMHP website at www.tmhp.com. [link]
For more information, call the TMHP Contact Center at 1-800-925-9126.
247 (08/25/17 through 09/15/17) *****Attention All Medicaid Providers*****The August 2017 Drug Labeler file is now available for clinician-administered drug (CAD) processing. The file identifies all drug labelers that participate in the Centers for Medicare & Medicaid Services (CMS) Drug Medicaid Rebate Program. The file is produced quarterly, about 45 days after the end of the calendar quarter. CAD processing instructions and frequently asked questions are also available. Details are available on the TMHP website at www.tmhp.com. [link]
248 (08/25/17 through 10/08/17)*****Attention Medicaid Providers*****TMHP will perform scheduled maintenance on Sunday, Oct. 8, 2017, from 4 p.m. until 11:59 p.m. All applications and functions will be unavailable during the system maintenance window.
249 (8/25/17 through 9/15/17) *****Attention All Medicaid Providers*****Effective for dates of service on or after October 1, 2017, prior authorization criteria for antisense oligonucleotide services will change for Texas Medicaid.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center cat 1-800-925-9126.
250 (08/25/17 through 09/22/17) *****Attention All Medicaid Providers*****HHSC is changing the definition of an individual speech therapy encounter. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
251 (09/01/17through 09/22/17) *****Attention All Medicaid Providers*****Providers unable to use the Electronic Visit Verification system by phone due to Hurricane Harvey will need to complete visit maintenance for those visits using Reason Code 130, Disaster or Emergency, to document service delivery in the EVV system.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
252 (09/01/17through 09/22/17) *****Attention All Medicaid Providers*****Effective for dates of service on or after Sept. 1, provider types and places of service will change for physical, occupational and speech therapy services for Texas Medicaid. Details are available on the TMHP website at www.tmhp.com. [link]
For more information, call the TMHP Contact Center, 1-800-925-9126.
253 (09/01/17 through 09/22/17) *****Attention All Providers*****TMHP will perform extended system maintenance from 7 p.m. Friday, September 29, 2017, until 11:59 p.m. Sunday, October 1, 2017. All applications and functions will be unavailable during the system maintenance window. For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
254 (09/01/17 through 09/22/17) *****Attention Medicaid Providers*****Beginning September 1, 2017, STAR, STAR Kids and STAR+PLUS managed care programs will begin providing services for certain Medicaid populations.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
255 (09/01/17 through 09/15/17) *****Attention All CSHCN Services Program Providers*****The Children with Special Health Care Needs (CSHCN) Services Program is releasing additional clarification of the definition of an individual speech therapy session, which was originally defined in the article titled, "Physical, Occupational, and Speech Therapy Benefits to Change for CSHCN Effective September 1, 2017," which was published on the TMHP website on July 12, 2017.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
256 (09/01/17/ through 09/15/17) *****Attention Medicaid Providers*****Effective for dates of services on or after September 1, 2017, reimbursement rate changes and updates for Texas Medicaid Therapy Services will be implemented.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126
257 (09/01/17 through 09/22/17) *****Attention All Medicaid and CSHCN Services Program Providers*****
On August 28, 2017, TMHP will make prior authorization letters available to access through the TMHP Prior Authorization on the Portal for Texas Medicaid and the Children with Special Healthcare Needs Services Program providers.Details are available on the TMHP website at www.tmhp.com. [link]
For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
258 (09/08/17 through 09/29/2017) *****Attention CSHCN Services Program Providers*****Effective for dates of services on or after September 1, 2017, the Children with Special Healthcare Needs (CSHCN) Services Program will align with Texas Medicaid reimbursement rate changes and updates for Therapy Services. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
259 (09/08/17 through 09/29/17) *****Attention All Medicaid Providers*****Reminder: Effective for dates of service on or after July 1, 2017, prior authorization is required for clients who are six years of age and younger for all Level 4 sedation/general anesthesia services (procedure code D9223, and procedure code 00170 with EP modifier) performed in conjunction with dental therapeutic services. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
260 (09/08/17 through 09/29/17) *****Attention All Medicaid Providers*****Effective Aug. 31, 2017, for dates of service on or after July 1, 2017, reimbursement rates for some Second Quarter 2017 Healthcare Common Procedure Coding System (HCPCS) procedure codes will change.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
261 (09/01/17 through 09/08/17) *****Attention All Providers*****Labor Day, Sept. 4, 2017, is a bank holiday. As a result, electronic funds transfer (EFT) payments will be delayed by one business day. Providers that receive EFT payments can expect funds by Monday, September 11, 2017. For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP CSHCN Services Program Contact Center at 1-800-568-2413.
262 (09/08/17 through 09/29/17) *****Attention All Medicaid Providers*****On September 1, 2017, TMHP implemented updates to the Claim Status Inquiry and 835 Explanation of Benefits (EOB) Crosswalk tables, which consist of Claim Status Codes (CSC), Claim Status Category Codes (CSCC), Claims Adjustment Reason Codes (CARC), Claims Adjustment Group Codes (CAGC), Remittance Advice Remarks Codes (RARC), and explanation codes that are associated with EOB denials. Explanation of benefits code 00794 was updated.
Providers can access the crosswalk table on TMHP's Electronic Data Interchange HIPAA Reference Files web page. Details are available on the TMHP website at www.tmhp.com. [link]
263 (09/08/17 through 09/29/17) *****Attention CSHCN Services Program Providers*****Effective for dates of service on or after September 1, 2017, reimbursement rates for some procedure codes for the Children with Special Health Care Needs (CSHCN) Services program will change. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP-CSHCN Services Program Contact Center at 1 800 568 2413.
264 (09/01/17 through 09/22/17) *****Attention All Medicaid and CSHCN Services Program Providers*****
On August 28, 2017, TMHP will make prior authorization (PA) letters available to access through the TMHP Prior Authorization on the Portal for Texas Medicaid and the Children with Special Healthcare Needs (CSHCN) Services Program providers. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
265 (09/01/17 through 09/22/17) *****Attention All Medicaid and CSHCN Services Program Providers*****
Effective for dates of discharge on or after September 1, 2017, Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program will continue to use version 34 (effective on October 1, 2016) of the All Patient Refined-Diagnosis Related Groups (APR-DRG) system.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
266 (09/01/17 through 09/22/17) *****Attention All Medicaid Providers*****The standard dollar amounts (SDAs) for dates of discharge on or after September 1, 2017, are now available for hospitals reimbursed through the All Patient Refined-Diagnosis Related Groups (APR-DRG) payment methodology.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
267 (09/01/17 through 09/22/17) *****Attention Comprehensive Care Program Providers*****There is an update to the Texas Medicaid Provider Procedures Manual, Home Health Nursing and Private Duty Nursing Services Handbook for Prescribed Pediatric Extended Care Centers (PPECC).Details are available on the TMHP website at www.tmhp.com. [link]
For more information, call the TMHP Contact Center at 1-800-925-9126.
268 (09/01/17 through 09/22/17) *****Attention Comprehensive Care Program Providers*****Effective June 1, 2017, rates are payable for Texas Medicaid's new benefit for Prescribed Pediatric Extended Care Centers (PPECC). The PPECC benefit is an alternative to private duty nursing (PDN). See the Texas Medicaid Provider Procedures Manual, Children's Services Handbook, 2.14 "Prescribed Pediatric Extended Care Centers (PPECC) (CCP)" for more information. Additional details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
269 (09/01/17 through 09/22/17) *****Attention Comprehensive Care Program Providers*****There is an update to the Texas Medicaid Provider Procedures Manual, Ambulance Services Handbook for Prescribed Pediatric Extended Care Centers (PPECC).Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
270 (09/01/17 through 09/22/17) *****Attention Comprehensive Care Program Providers*****There is an update to the Texas Medicaid Provider Procedures Manual, Certified Respiratory Care Practitioner (CRCP) Services Handbook as related to Prescribed Pediatric Extended Care Centers (PPECC).Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
271 (09/08/17 through 09/29/17) *****Attention All Medicaid Providers*****On September 15, 2017, the Vendor Drug Program will modify the Antiviral Agents for Hepatitis C Virus Initial Request Prior Authorization Request Form.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
272 (09/08/17 through 09/29/17) *****Attention All Medicaid Providers*****On September 15, 2017, the Vendor Drug Program will modify the Antiviral Agents for Hepatitis C Virus Initial Request Prior Authorization Request Form.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
273 (09/08/17 through 09/29/17) *****Attention All Medicaid Providers*****The Texas Drug Utilization Review Board held its quarterly meeting on July 28, 2017, to make recommendations for the Texas Medicaid program's clinical prior authorizations and preferred drug list (PDL). A summary of the July board meeting is available at the Vendor Drug Program website. Details are available on the TMHP website at www.tmhp.com. [link]
274 (09/15/17 through 10/06/17) *****Attention All Providers*****TMHP will perform extended system maintenance from 7 p.m. Friday, October 20, 2017, until 5 a.m. Monday, October 23, 2017. Provider Enrollment on the Portal and the Online Provider Lookup applications will be unavailable during the system maintenance window. Providers can continue to use all other applications and functions with the exception of the two listed above.For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
275 (09/08/17 through 09/29/17) *****Attention All Medicaid and CSHCN Services Program Providers*****
The Health and Human Services Commission (HHSC) has requested that TMHP publish the following information:Due to the impact of Hurricane Harvey and pending decisions that may impact the implementation of the Federal Regulation to require all ordering, referring or prescribing providers to be enrolled as participating providers in Medicaid, HHSC is delaying the deployment of this requirement.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
276 (9/15/2017 through 10/06/2017) *****Attention ALL Medicaid and CSHCN Services Program Providers*****
Effective October 1, 2017, TMHP added new taxonomy codes associated with allopathic and osteopathic physicians. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
277 (09/22/17 through 10/13/17) *****Attention All Medicaid Providers*****The Vendor Drug Program will make updates to clinical prior authorizations on September 27, 2017. Details are available on the TMHP website at www.tmhp.com. [link]
For more information, call the TMHP Contact Center at 1-800-925-9126.
278 (09/22/17 through 10/13/17) *****Attention All Medicaid Providers*****HHSC will not implement reimbursement rate changes on October 1, 2017, for Dental and Ambulance services proposed at the August 8, 2017, public rate hearing. No specific time frame or effective date for the future adjustments has been established.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
279 (09/15/17 through 10/06/17) *****Attention All Medicaid Providers*****TMHP will perform scheduled maintenance on Sunday, Nov. 5, 2017, from 12:01 p.m. until 3:00 a.m. During the system maintenance window, all applications and functions will be unavailable.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
280 (9/15/2017 through 10/06/2017) *****Attention All Medicaid Providers*****The U.S. Department of Health & Human Services (HHS) has declared that Hurricane Harvey represents a public health emergency in Texas. Providers that are not currently enrolled with Texas Medicaid, but are rendering services to Texas Medicaid eligible clients affected by Hurricane Harvey, can complete a temporary provider enrollment application, which will expedite the enrollment process.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
281 (09/29/17 through 10/20/17) *****Attention All Medicaid Providers*****Effective for dates of service from October 1, 2017, through September 30, 2018, the Federal Medical Assistance Percentage (FMAP) will change from 56.18 percent to 56.88 percent.Effective for dates of service from Oct. 1, 2017, through Sept. 30, 2018, the Enhanced Federal Medical Assistance Percentage (EFMAP) will change from 92.33 percent to 92.82 percent. This change will not affect provider reimbursement.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
282 (09/29/17 through 10/20/17) *****Attention All Medicaid Providers*****The YourTexasBenefitsCard.com website offers Medicaid providers instant access to available health information and eligibility verification of Medicaid patients enrolled in managed care or fee-for-service. A
quick tutorial is available for providers to learn how to enhance practice efficiency, care coordination, and patient outcomes.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the YTBC Help Desk at 1-855-827-3747.
283 (09/29/17 through 10/20/17) *****Attention HTW Providers*****On Aug. 25, 2017, Hurricane Harvey hit the Texas coast and caused significant damage and flooding in numerous counties, forcing many people to evacuate to temporary locations.Texas Health and Human Services (HHS) is committed to sharing important Hurricane Harvey information with providers and will provide the tools and resources needed to ensure the provision of services and support to needy residents in Texas in the aftermath of this natural disaster. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
284 (09/22/17 through 10/13/17) *****Attention All Medicaid Providers*****Texas Medicaid has developed additional medical necessity criteria to improve access to breast pump equipment for breastfeeding mothers and their infants.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
285 (09/22/17 through 10/13/17) *****Attention All Medicaid Providers*****This is an update to an article titled "Proposed Reimbursement Rate Changes for Texas Medicaid to Be Effective July 1, 2017 and October 1, 2017," which was published on TMHP website on July 27, 2017.Effective for dates of services on or after July 1, 2017 and October 1, 2017, reimbursement rate changes presented at a public rate hearing on August 8, 2017, will be implemented with the exception of Dental and Ambulance Services. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
286 (09/22/17 through 11/12/17) *****Attention All Medicaid Providers*****TMHP will perform scheduled system maintenance on Sunday, Nov. 12, 2017, from 4 p.m. until 11:59 p.m. All applications and functions will be unavailable during the system maintenance window.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
287 (09/29/2017 through 10/20/2017) *****Attention All Medicaid Providers*****There is an update to the current Texas Medicaid Provider Procedures Manual, Volume 2, Vision and Hearing Services Handbook, subsection 2.2.4.3, "Limitations." This update will become effective for dates of service on or after October 1, 2017.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
288 (10/06/17 through 10/27/17) *****Attention All Medicaid Providers*****As a result of Hurricane Harvey, Texas Medicaid and the Texas Medicaid managed care organizations (MCOs) have issued temporary electronic visit verification (EVV) policy changes for Texas Health and Human Services regions and MCO service delivery areas declared a disaster.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
289 (10/6/17 through 10/27/17) *****Attention All Texas Health Steps Providers*****The Texas Health Steps Quick Reference Guide has been updated. Under the column titled "Immunizations Administered," vaccine procedure code 90682 was added to the influenza section. The updated document is available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
290 (10/06/17 through 10/27/17) *****Attention All Healthy Texas Women Providers*****Healthy Texas Women (HTW) providers intending to provide, or continue providing, HTW services must complete the certification process by Dec. 31, 2017, for the 2018 program year. The PIMS Instructions for HTW Certification and Attestation are located on the HTW web page at www.tmhp.com. [link]
291 (10/06/17 through 10/27/17) *****Attention All Medicaid Providers*****The monthly Texas National Drug Code (NDC) to Healthcare Common Procedure Coding System (HCPCS) Crosswalk is now available for Clinician-Administered Drugs (CAD) processing. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
292 (10/06/17 through 10/27/17) *****Attention All Medicaid Providers*****On Sept. 10, 2017, TMHP implemented the third quarter 2017 Healthcare Common Procedure Coding System (HCPCS) additions, revisions and discontinuations, which will be effective for dates of service on or after Oct. 1, 2017.
Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
293 (10/06/17 through 10/27/17) *****Attention All CSHCN Services Program Providers*****On Sept. 10, 2017, TMHP implemented the third quarter 2017 Healthcare Common Procedure Coding System (HCPCS) additions, revisions, and discontinuations, which will be effective for dates of service on or after Oct. 1, 2017.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
294 (10/13/17 through 11/03/17) *****Attention All Medicaid Providers*****There is an update to the article titled, "The September 2017 Texas NDC to HCPCS Crosswalk is now available," which was published on the TMHP website on September 29, 2017. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
295 SR- 6331055 Banner/Website(10/06/17 through 10/13/17) *****Attention All Providers*****Monday, Oct. 9, 2017, is Columbus Day, which is a bank holiday. As a result, electronic funds transfer (EFT) payments will be delayed by one business day. Providers that receive EFT payments can expect funds by Monday, Oct. 16. For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
296 (10/13/17 through 11/03/17) *****Attention All Medicaid and CSHCN Services Program Providers*****
Effective Oct. 1, 2017, the fourth quarter 2017 National Correct Coding Initiative updates were implemented for claims processed by TMHP for Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
297 (10/20/17 through 11/10/17) *****Attention All Medicaid Providers*****The Texas Health and Human Services executive commissioner set a goal for 90 percent of all children who enter Department of Family and Protective Services custody to receive a Texas Health Steps medical checkup during the first 30 days of DFPS legal custody.
Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
298 (10/20/17 through 12/03/17) *****Attention All Medicaid Providers*****TMHP will perform scheduled system maintenance on Sunday, Dec. 3, 2017, from 4 p.m. until 11:59 p.m. All applications and functions will be unavailable during the system maintenance window.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
299 (10/20/17 through 11/10/17) *****Attention All Medicaid and CSHCN Services Program Providers*****
Updates to Provider Enrollment on the Portal (PEP), the Online Provider Lookup (OPL), Provider Information Management System (PIMS), and TMHP Portal Account Activation will be effective Oct. 27, 2017.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
300 (10/20/17 through 11/10/17) *****Attention All Medicaid Providers*****There is an update to the article titled, "Infliximab Procedure Code Q5102 to Become a Benefit of Texas Medicaid Effective Oct. 1, 2017," which was published on the TMHP website Aug. 11, 2017.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
301 (10/20/17 through 11/10/17) *****Attention All Medicaid and CSHCN Services Program Providers*****
Updates to Provider Enrollment on the Portal (PEP), the Online Provider Lookup (OPL), Provider Information Management System (PIMS), and TMHP Portal Account Activation will be effective Oct. 27, 2017.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
302 (10/27/17 through 11/17/17) *****Attention All Medicaid Hospital Providers*****Effective Oct. 27 the Provider Portal will include new Medlog encounter reports for hospitals and inpatient rehabilitation centers.
Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
303 (10/20/17 through 11/10/17) *****Attention All Medicaid Providers*****Effective for dates of service on or after Dec. 1, 2017, benefits for obstetric procedure codes 59812, 59820, and 59821 will change for Texas Medicaid.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
304 (10/27/17 through 11/17/17) *****Attention Medicaid and CSHCN Services Program Providers*****
Effective for dates of discharge on or after October 1, 2017, Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program will use version 35 of the All Patient Refined-Diagnosis Related Groups system to process inpatient claims.Details are available on the TMHP website at www.tmhp.com. [link]
305 (10/27/17 through 11/10/17) *****Attention Medicaid and CSHCN Services Program Providers*****
Effective Nov. 1, 2017, the reimbursement for anesthesiologists directing one or multiple certified registered nurse anesthetists (CRNAs) and/or anesthesiologist assistants (AAs) during medical procedures will change and apply for Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
306 (10/27/17 through 11/17/17) *****Attention All Medicaid Providers*****The monthly 2017 Texas NDC to HCPCS Crosswalk is now available for clinician-administered drug (CAD) processing. Details are available on the TMHP website at www.tmhp.com. [link]
307 (10/27/17 through 11/17/17) *****Attention All Medicaid Providers*****The agenda for the Friday, Nov. 3, 2017 Texas Drug Utilization Review Board meeting is available.Details are available on the TMHP website at www.tmhp.com. [link]
308 (11/10/17 through 12/01/17) *****Attention All Providers*****TMHP will perform extended system maintenance on Friday, Dec. 8, 2017, from 7 p.m. to 11:59 p.m. on Sunday, Dec. 10, 2017. All applications and functions will be unavailable during the system maintenance window with the exception of Texas Medicaid and the Children with Special Needs (CSHCN) Services Program phone and fax operations. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
309 (11/03/17 through 11/24/17) *****Attention All Medicaid and CSHCN Services Program Providers*****
Updates to Provider Enrollment on the Portal (PEP), Online Provider Lookup (OPL), Provider Information Management System (PIMS) and TMHP Portal Account Activation are effective Oct. 27, 2017.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
310 (11/03/17 through 11/24/17) *****Attention Medicaid Providers*****Effective for dates of service on or after Nov. 1, 2017, The Health and Human Services Commission (HHSC) will implement reimbursement changes for Texas Medicaid anesthesia services provided by anesthesiologist (solely performing a medical service), a certified registered nurse anesthetist (CRNA) or anesthesiologist assistant (AA) while performing a medical service and supervised by an anesthesiologist, and a CRNA who performs a medical service while supervised by a physician (billing independently). The proposed rates were presented at the public rate hearing on Sept. 20, 2017. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
311 (11/03/17 through 11/24/17) *****Attention All Providers*****TMHP has extended the 95-day claims filing deadline to 120 days from the date of service for claims submitted by Fee-for-Service, Healthy Texas Women program, Family Planning Program, and Children with Special Health Care Needs Services Program providers located in a Federal Emergency Management Agency (FEMA)-declared disaster county. The extension only applies to claims submitted for dates of service from Aug. 11, 2017, until the date on which the disaster declaration is rescinded.For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
312 (11/03/17 through 11/24/17) *****Attention All Medicaid Providers*****TMHP has identified an issue that affects claims submitted with dates of service on or after July 1, 2017, and procedure code 00170 with modifier EP or procedure code D9223. These claims may have been incorrectly denied, and future claims could also be incorrectly denied.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
313 (11/10/17 through 12/01/17) *****Attention All Medicaid Providers*****Effective October 31, 2017, for dates of service on or after October 1, 2017, reimbursement rates for some Third Quarter 2017 Healthcare Common Procedure Coding System (HCPCS) will change.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
314 (11/10/17 through 12/01/17) *****Attention All Clinician-Directed Care Coordination Providers*****
Effective immediately, Comprehensive Care Program clinician-directed care coordination services procedure codes 99358 and 99359 for non-face-to-face prolonged services may be used for completion of paperwork required by a judge to determine guardianship of a client. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
315 (11/10/17 through 12/01/17) *****Attention All Medicaid Providers*****Effective Oct. 27, 2017, Kymriah is a payable benefit of Texas Medicaid. Kymriah was added to the October 2017 National Drug Code to Healthcare Common Procedure Coding System Crosswalk available on the Vendor Drug Program website. Details are available on the TMHP website at www.tmhp.com.[link]
316 (11/10/17 through 12/01/17) *****Attention All CSHCN Services Program Providers*****TMHP has identified an issue that affects claims submitted with dates of service on or after July 1, 2017, and procedure code 00170 with modifier EP or procedure code D9223. These claims may have been incorrectly denied, and future claims could also be incorrectly denied.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
317 (11/10/17 through 12/01/17) *****Attention All Medicaid Providers*****Beginning Nov. 1, 2017, information regarding expendable medical supplies and durable medical equipment for clients who are 20 years of age and younger is moving to the Texas Medicaid Provider Procedures Manual Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9125.
318 (11/17/17 through 12/08/17) *****Attention All CSHCN Services Program Providers*****Effective for dates of service on or after December 1, 2017, benefits for blood factor products will change for the Children with Special Health Care Needs (CSHCN) Services Program.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
319 (11/17/17 through 12/08/17) *****Attention All CSHCN Services Program Providers*****Effective for dates of service on or after December 1, 2017, infliximab procedure code Q5102 will become a benefit of the Children with Special Health Care Needs (CSHCN) Services Program.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
320 (11/10/17 through 12/01/17) *****Attention All Medicaid, CSHCN Services Program and HTW Providers*****
There is an update to the article titled, "Delayed Implementation for Required Enrollment of All Ordering, Referring or Prescribing Providers," which was published on the TMHP website on September 1, 2017. Beginning January 15, 2018, claims for the payment of items and services that were ordered, referred or prescribed must contain the National Provider Identifier of the physician or other professional who ordered, referred or prescribed the items or services. Additionally, all ordering, referring or prescribing providers are required to be enrolled as participating providers in Texas Medicaid. These requirements impact the Medicaid, Healthy Texas Women, and Children with Special Health Care Needs Services programs only. However, these requirements do not apply to out-of-network providers that order, refer or prescribe only for managed care members.Details are available on the TMHP website at www.tmhp.com. [link]
321 (11/17/17 through 12/08/17) *****Attention All Medicaid and CSHCN Services Program Providers*****
There is a correction to the All Patient Refined Diagnosis Related Group (APR-DRG) Grouper 35 file posted on the TMHP website, which was effective for inpatient hospital claims with discharge dates on or after October 1, 2017.
Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
322 (11/10/17 through 12/01/17) *****Attention All Medicaid and CSHCN Service Program Providers*****
There is an update to an article titled, "Update to 'Claims Submitted on Institutional Format Must Include the National Provider Identifier of the Rendering Provider,'" which was published on the TMHP website on June 2, 2017.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
323 (11/17/17 through 12/08/17) *****Attention All Hospital Providers*****TMHP has identified an issue that impacts some inpatient hospital claims submitted with newborn weight diagnosis codes. Some of these claims were processed as ungroupable with DRG 9560. Claims submitted with a date of discharge of Oct. 1, 2016, and after will be reprocessed to allow providers to submit an appeal. Providers must submit appeals and include newborn weight diagnosis codes per ICD-10 diagnosis coding guidelines.For more information, call the TMHP Contact Center at 1-800-925-9126.
324 (11/24/17 through 12/15/17) *****Attention All Providers*****Effective Jan. 1, 2018, for dates of service on or after Jan. 1, 2018, TMHP will apply the 2018 Healthcare Common Procedure Coding System (HCPCS) additions, changes and deletions. Deleted procedure codes will no longer be benefits of Texas Medicaid or the Children with Special Health Care Needs (CSHCN) Services Program.The information will be available on the TMHP website at www.tmhp.com on Jan. 1, 2018. For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
325 (11/24/17 through 12/15/17) *****Attention All Medicaid Providers*****Effective Jan. 1, 2018, private duty nursing benefit language will be clarified for Texas Medicaid.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
326 (11/24/17 through 12/15/17) *****Attention All Medicaid Providers*****Effective for dates of service on or after Jan. 1, 2018, newborn hearing screening benefits will be clarified for Texas Medicaid.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
327 (11/24/17 through 12/15/17) *****Attention All Medicaid and CSHCN Services Program Providers*****
Effective Jan. 1, 2018, Texas Health Steps and Children with Special Health Care Needs Services Program dental services rendered by a substitute dentist may be billed to TMHP using the substitute dentist's National Provider Identifier (NPI), which must be indicated in Block 35 of the American Dental Association 2012 claim form. Modifier U5 must be indicated in Block 19 of the American Dental Association claim form. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
328 (11/24/17 through 12/15/17) *****Attention CSHCN Services Program Providers*****Effective for dates of service on or after Dec. 1, 2017, reimbursement rates for some Children with Special Health Care Needs (CSHCN) Services Program procedure codes will change. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
329 (11/24/17 through 12/15/17) *****Attention All CSHCN Services Program Providers*****Effective for dates of service on or after Dec. 1, 2017, prior authorization will no longer be required for most chemodenervation procedure codes for the Children with Special Health Care Needs (CSHCN) Services Program.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
330 (11/24/17 through 12/15/17) *****Attention All Medicaid Providers*****Effective for dates of service on or after Jan. 1, 2018, benefits for cardiac device evaluation procedure codes 93297 and 93290 will change for Texas Medicaid. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
331 (12/01/17 through 12/22/17) *****Attention All Medicaid Providers*****Effective for dates of service on or after Jan. 1, 2018, Immunostimulant Sipuleucel-t procedure code Q2043 will become a benefit for Texas Medicaid.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
332 (12/01/17 through 12/22/17) *****Attention All Medicaid and CSHCN Services Program Providers*****
TMHP has made an updated Provider Information Management System Provider Information Change FORM available on the TMHP website under "Provider Enrollment - Forms."Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
333 (11/17/17 through 01/17/18) *****Attention All Providers*****TMHP will perform scheduled system maintenance from 8 a.m., Sunday, Jan. 14, 2018, through 3 a.m. on Monday, Jan. 15. All applications and functions will be unavailable during the system maintenance window.For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
334 (12/01/17 through 12/22/17) *****Attention All Medicaid Providers*****The monthly Texas National Drug Codes Healthcare Common Procedure Coding System Crosswalk is now available for clinician-administered drug processing.Details are available on the TMHP website at www.tmhp.com. [link]
335 (12/01/17 through 12/22/17) *****Attention All Medicaid Providers*****The November 2017 Drug Labeler Directory (for Texas Centers for Medicare & Medicaid Services fiscal year 2017, third quarter) is now available for clinician-administered drug processing. Details are available on the TMHP website at www.tmhp.com. [link]
336 (12/01/17 through 12/22/17) *****Attention All Medicaid Providers*****HHSC has retired its Electronic Health Record Incentive Program online computer-based training courses formerly located at www.texasehrincentive.com. Links to the courses have been removed from the TMHP website.For more information, call the TMHP Contact Center at 1-800-925-9126.
337 (12/08/17 through 12/29/17) *****Attention All Medicaid Providers*****TMHP has identified an issue that impacts the Certified Registered Nurse Anesthetist / Anesthesiologist Assistant static fee schedule available for download www.tmhp.com. The fee schedule posted Nov. 2, 2017, does not reflect the correct reimbursement rates for CRNA services for some type of service 1 and TOS 2 anesthesia procedure codes. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
338 (12/08/17 through 12/29/17) *****Attention All Medicaid and CSHCN Services Program Providers*****
The filing deadline extension ending for Fee-for-Service, Healthy Texas Women program, Family Planning program, and Children with Special Health Care Needs Services Program providers located in a Federal Emergency Management Agency-declared disaster county is effective Dec. 1, 2017.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
339 (12/08/17 through 12/29/17) *****Attention All CSHCN Services Program Providers*****Effective for dates of services on or after Dec 1, 2017, the Children with Special Healthcare Needs Services Program will align with Texas Medicaid. Services rendered by a therapy assistant (billed with modifier UB) will be reimbursed 85 percent of the rate paid to a licensed therapist. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
340 (12/08/17 through 12/29/17) *****Attention All Medicaid Providers*****HHSC is in the process of amending its telemedicine and telehealth benefits to implement Senate Bill (SB) 1107, which was passed during the 85th Texas Legislature, Regular Session, 2017.Details are available on the TMHP website at www.tmhp.com. [link]
341 (12/08/17 through 12/29/17) *****Attention All Medicaid Providers*****The Texas Drug Utilization Review Board held its quarterly meeting on Nov. 2, 2017, to make recommendations for Texas Medicaid's clinical prior authorizations and preferred drug list. A summary of the November board meeting is available at the Vendor Drug Program website. The next board meeting is scheduled for Friday, Jan. 26, 2018.Details are available on the TMHP website at www.tmhp.com. [link]
342 (12/08/17 through 12/29/17) *****Attention All Medicaid and CSHCN Services Program Providers*****
Claims for authorized procedure codes that are manually priced must list the claims detail information in the same order as itemized on the authorization letter.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
343 (12/15/17 through 1/05/18) *****Attention All Texas Health Steps Providers*****This is a reminder to Texas Health Steps providers of the importance of documenting the complete Texas Health Steps checkup. Each of the six checkup components and their individual elements must be completed at the time of the checkup and documented in the medical record. Two critical checkup components to be emphasized are the requirement to provide vaccines and complete laboratory screening according to the periodicity schedule and laboratory submission requirements, both at the time of the checkup.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
344 (12/15/17 through 01/12/18) *****Attention All Medicaid and CSHCN Providers*****Effective for dates of service on or after Nov. 1, 2017, anesthesia services provided by a resident physician and medically directed by an anesthesiologist must use the applicable procedure code and modifiers AA, U1 and GC (informational only) when a single claim per client is billed for Texas Medicaid and the Children with Special Health Care Needs Services Program.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
345 (12/15/17 through 1/05/18) *****Attention All Providers*****Google has identified an issue with the most recent version of the Google Chrome browser that could affect users of TMHP portal applications. Users experiencing issues with TMHP portal applications while using this most recent version of Chrome should use either Internet Explorer 11, Firefox, or an older version of Chrome. Google has confirmed a fix for the Chrome issue is scheduled for release on Dec. 5, 2017.For more information, call the TMHP EDI Helpdesk at 1-888-863-3638.
346 (12/15/17 through 01/05/18) *****Attention All Healthy Texas Women Program Providers*****Effective for dates of service on or after Sept. 1, 2017, influenza virus vaccine procedure codes 90686 and 90688 will become benefits of the Healthy Texas Women program.
Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
347 (12/22/17 through 12/29/17) *****Attention All Providers*****Monday, Dec. 25, 2017, is Christmas Day, which is a bank holiday. As a result, electronic funds transfer payments will be delayed by one business day. Providers that receive EFT payments can expect funds by Tuesday, Jan. 2, 2018. For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
348 (12/22/17 through 01/12/18) *****Attention All Family Planning Program Providers*****Effective for dates of service on or after Sept. 1, 2017, some evaluation and management procedure codes will be reimbursed for Family Planning Program providers billing for prenatal visits with the TH modifier. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
349 (12/22/17 through 01/12/18) *****Attention All Medicaid Providers*****TMHP has identified an issue that impacts reimbursement for assistant surgery procedure codes 35621 and 35694 for clients 21 years old to 999 years old. Claims may have been paid incorrectly. Affected claims submitted for dates of service on and after April 1, 2016, will be reprocessed. No action is required by providers. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
350 (12/22/17 through 01/12/18) *****Attention All Medicaid CCP Providers*****TMHP has identified an issue with Inpatient Hospital claims submitted by some psychiatric hospitals and rehabilitation facilities for Medicaid clients 21 years of age or older. Claims submitted for these clients with dates of service prior to Dec. 8, 2017, may have been reimbursed in error. Comprehensive Care Program-only providers may not be reimbursed for Inpatient Hospital claims for Medicaid clients 21 years of age or older for these providers. These claims may be subject to reprocessing. If claims are to be reprocessed, information will be provided in a future provider notification. For more information, call the TMHP Contact Center at 1-800-925-9126.
351 (12/22/17 through 01/12/18) *****Attention All Medicaid Providers*****Effective for dates of service on or after Feb. 1, 2018, procedure code 90792 will no longer be reimbursed to Case Management/Home- and Community-Based Services providers. For more information, call the TMHP Contact Center at 1-800-925-9126.
352 (12/22/17 through 01/12/18) *****Attention All Medicaid Providers*****Effective Jan. 1, 2018, for dates of service on or after Jan. 1, 2018, some changes will apply for Clinical Laboratory Improvement Amendment waived tests. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
353 (12/22/17 through 01/12/18) *****Attention All Medicaid Providers*****Pending final approval of the Nov. 16, 2017 rate hearing adjustments, the modifier to be submitted with services related to dental general anesthesia will change for Texas Medicaid. This change will be effective for dates of service on or after Feb. 1, 2018.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
354 (12/22/17 through 01/19/18) *****Attention Medicaid Providers*****Effective for dates of service on or after Jan. 1, 2018, psychotherapy and psychiatric diagnostic evaluation and psychological, neurobehavioral and neuropsychological testing services benefits will be updated for Texas Medicaid.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
355 (12/22/17 through 01/12/18) *****Attention All Medicaid Providers*****The request for medical records faxed to providers will include a revised Business Records Affidavit. The Inspector General/Utilization Review no longer requires a Client Record Inventory Form.Providers must complete and submit the revised affidavit for each medical record requested for review.IG-UR will not accept medical records without a properly completed and notarized affidavit. For more information, call the TMHP Contact Center at 1-800-925-9126.
356 (12/22/17 through 01/12/18) *****Attention All Medicaid Providers*****The Texas Medicaid Quick Reference Guide has been updated to include the 2018 filing deadline calendar. The updated document is available at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
357 (12/22/17 through 01/12/18) *****Attention All CSHCN Services Program Providers*****Effective for dates of service on or after Feb. 1, 2018, the modifier to be submitted with procedure code 00170 for dental general anesthesia will change for the Children with Special Health Care Needs Services Program.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
358 (12/22/17 through 01/19/18) *****Attention CSHCN Services Program Providers*****Effective for dates of service on or after Jan. 1, 2018, chemotherapy procedure code G0498 will become a benefit for the Children with Special Health Care Needs Services Program.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP-CSHCN Services Program Contact Center at1-800-568-2413.
359 (12/22/17 through 01/19/18) *****Attention CSHCN Services Program Providers*****Effective for dates of service on or after Feb. 1, 2018, benefits will change for wheelchair cushion procedure codes for the Children with Special Health Care Needs Services Program.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
360 (12/22/17 through 01/12/18) *****Attention CSHCN Services Program Providers*****Effective for dates of service on or after Feb. 1, 2018, cervical orthoses procedure code L0113 will become a benefit of the Children with Special Health Care Needs Services program.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
361 (12/29/17 through 01/19/17) *****Attention All Medicaid Providers*****HHSC has published an update to the December 2017 Texas National Drug Codes-to-Healthcare Common Procedure Coding System Crosswalk. Details are available on the TMHP website at www.tmhp.com. [link]
362 (12/29/17 through 01/19/17) *****Attention All Medicaid Providers*****The mosquito repellent benefit for Zika virus prevention is scheduled to end Dec. 31, 2017. Clients must request and obtain mosquito repellent from a participating pharmacy by Dec. 31 to be eligible for the benefit.
363 (12/29/17 through 01/19/18) *****Attention All Medicaid and CSHCN Services Program Providers*****
The paper Provider Information Change Form was updated with an effective date of Nov. 1, 2017. TMHP will accept previous versions of the PIC form through March 31, 2018. Effective April 1, 2018, TMHP will only accept the new PIC form.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
364 (12/29/17 through 01/19/18) *****Attention All Medicaid and Medical Transportation Program Providers *****
The Centers for Medicare & Medicaid Services has published the provider enrollment application fee for calendar year 2018 in the Federal Register. Effective Jan. 1, 2018, the application fee for institutional providers submitting new enrollment applications or reenrollment applications for Texas Medicaid and the Medical Transportation Program will be $569.00.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
365 (12/29/17 through 01/19/18) *****Attention All CSHCN Services Program Providers*****Effective Jan. 1, 2018, for dates of service on or after July 1, 2016, some changes will apply for Clinical Laboratory Improvement Amendment-waived tests. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
366 (12/22/17 through 02/12/18) *****Attention All Providers*****TMHP will perform scheduled maintenance on Sunday, Feb. 11, 2018, from 1 p.m. until 11:59 p.m. All applications and functions will be unavailable during the system maintenance window.For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
367 (12/29/17 through 01/19/18) *****Attention All Medicaid Providers*****Effective for dates of service on or after June 1, 2016, procedure code A6250 may be reimbursed as Medicaid-only. Providers are not required to submit this procedure code to Medicare before submitting it to Medicaid for services rendered to dual-eligible clients.Affected claims billed to Medicare for procedure code A6250 and type of service 9, for dates of service from June 1, 2016, through Nov. 2, 2017, which were denied, will be reprocessed. Providers may receive additional payment, which will be reflected on future Remittance and Status reports.
For more information, call the TMHP Contact Center at 1-800-925-9126.
368 (12/29/17 through 01/19/17) *****Attention All Medicaid Providers*****Effective Jan. 1 2018, Texas Medicaid will move certain products manufactured by Women's Choice to non-preferred status on Formulary.Details are available on the TMHP website at www.tmhp.com. [link]
369 (12/29/17 through 01/19/17) *****Attention All Medicaid Providers*****The monthly Texas National Drug Codes-to-Healthcare Common Procedure Coding System Crosswalk is now available for clinician-administered drug processing.Details are available on the TMHP website at www.tmhp.com. [link]
370 (12/29/17 through 01/05/18) *****Attention All Providers*****Monday, Jan. 1, 2018, is New Year's Day, which is a bank holiday. As a result, electronic funds transfer payments will be delayed by one business day. Providers that receive EFT payments can expect funds by Monday, Jan. 8, 2018. For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
371 (12/29/17 through 01/19/17) *****Attention All Medicaid Providers*****Effective Jan. 25, 2018, Texas Medicaid will implement the semi-annual update of the Medicaid preferred drug list (PDL). The update is based on changes presented at the July and November 2017 Texas Drug Utilization Review (DUR) Board meetings.Details are available on the TMHP website at www.tmhp.com. [link]
372 (01/05/18 through 01/26/18 *****Attention CSHCN Services Program Providers*****Reimbursement rates for some Children with Special Health Care Needs Services Program, 2016 Second Quarter and Third Quarter Healthcare Common Procedure Coding System procedure codes will become effective on Jan. 1, 2018, for dates of service on or after Jan. 1. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
373 (01/05/18 through 01/26/18) *****Attention All Medicaid Providers*****Effective for dates of service on or after April 1, 2018, proposed reimbursement rate changes will be presented at a public rate hearing on Feb. 7, 2018. Implementation of these reimbursement rates is pending. Providers will be notified when a final decision has been made.Details are available on the TMHP website at www.tmhp.com. [link]
For more information, call the TMHP Contact Center at 1-800-925-9126.
374 (01/05/18 through 01/26/18) *****Attention All Providers*****The 2018 Healthcare Common Procedure Coding System additions, changes, and deletions effective for dates of service on or after Jan. 1, 2018, are now available in the January 2018 HCPCS Special Bulletin, No. 13, on the Code Updates - HCPCS page of tmhp.com. Deleted procedure codes are no longer benefits of Texas Medicaid or the Children with Special Health Care Needs Services Program.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
375 (01/05/18 through 01/26/18) *****Attention All Medicaid and CSHCN Services Program Providers*****
Effective Jan. 1, 2018, the first quarter 2018 National Correct Coding Initiative updates will be implemented for claims processed by TMHP for Texas Medicaid and the Children with Special Health Care Needs Services Program.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
376 (01/05/18 through 01/26/2017) *****Attention All Medicaid Providers*****Effective for dates of service on or after Jan. 1, 2017 and Jan. 1, 2018, reimbursement rate changes and updates for some procedure codes that were presented at a public rate hearing on Nov. 16, 2017, are now available.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
377 (01/05/18 through 01/26/18) *****Attention All Medicaid Providers*****TMHP has identified an issue that affects claims submitted with medical supply procedure code A7000. Procedure code A7000 does not require prior authorization. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 1-800-925-9126.
