Banner Messages for All of the 2020 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 2018 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 2020)
1 (12/13/19 through 01/03/20) *****Attention All Medicaid Providers*****The Texas Drug Utilization Review (DUR) Board met October 25, 2019, to make recommendations for Medicaid clinical prior authorizations and the preferred drug list. A summary of this meeting is now available on the Texas Vendor Drug Program (VDP) website.Details are available on the TMHP website at www.tmhp.com. [link]
2 (12/13/19 through 01/03/20) *****Attention All Medicaid and CSHCN Services Program Providers*****
Reminder: Effective January 1, 2020, dental providers must use the 2018 or the 2019 versions of the American Dental Association (ADA) claim form.TMHP will accept the 2012 version of the ADA claim form through December 31, 2019. Effective January 1, 2020, TMHP will accept only the 2018 or 2019 versions of the claim form.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
3 (12/13/19 through 01/03/20) *****Attention All Medicaid Providers*****Reminder: All client medical record entries must be legible to individuals other than the author, dated (month, day, and year), and signed by the performing provider.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 (12/13/19 through 01/03/20) *****Attention All Medicaid Providers*****Beginning December 14, 2019, Substance Abuse and Mental Health Services Administration-certified Opioid Treatment Providers who are licensed as Narcotic Treatment Programs may submit provider enrollment applications for Texas Medicaid through TMHP. Provider Enrollment on the Portal will be available for enrollment on December 14, 2019.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
5 (12/13/19 through 01/03/20) *****Attention All Medicaid and CSHCN Services Program Providers*****
Beginning February 1, 2020, TMHP will add clarifying language for after-hours services to the Texas Medicaid Provider Procedures Manual and the Children with Special Health Care Needs (CSHCN) Services Program Provider Manual.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
6 (12/13/19 through 01/03/20) *****Attention All Medicaid Providers*****Effective for dates of service on or after February 1, 2020, allergy testing evaluation and management services benefit language will be updated in the Texas Medicaid Provider Procedures Manual.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
7 (12/13/19 through 01/03/20) *****Attention All Medicaid Providers*****Beginning February 1, 2020, TMHP will update the limitation for procedure code 84583 in the Texas Medicaid Provider Procedures Manual.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
8 (12/20/19 through 01/10/20) *****Attention All Medicaid Providers*****The American Society of Health-System Pharmacists website Drug Shortage page states that Lupin has placed Ciprofloxacin oral suspension on long-term back order and the company cannot estimate a release date.Details are available on the TMHP website at www.tmhp.com. [link]
9 (12/20/19 through 01/10/20) *****Attention All Medicaid Providers*****Effective for dates of service on or after February 1, 2020, diagnostic Doppler sonography 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 800-925-9126.
10 (12/20/19 through 01/10/20) *****Attention All CSHCN Services Program Providers*****Prior authorization for incontinence supplies (diapers, pull-ups, briefs, or liners) outside of allowable quantity limitations or for non-covered diagnoses in medical policy and prior authorization for all other expendable medical supplies outside of allowable quantity limitations must be submitted on the correct CSHCN Services Program prior authorization forms.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
11 (12/27/19 through 01/03/20) *****Attention All Providers*****Wednesday, January 1, 2020, is New Year's Day, a bank holiday. As a result, electronic funds transfer (EFT) payments may be delayed by one business day. Providers that receive EFT payments can expect funds by Monday, January 6, 2020.For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
12 (12/27/19 through 01/17/20) *****Attention All Medicaid Providers*****Texas is currently preparing for the next Payment Error Rate Measurement (PERM) review, which will begin in the spring of 2020. The review will include Texas Medicaid and the Children's Health Insurance Program (CHIP) claims paid from July 1, 2019, through June 30, 2020.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 (12/20/19 through 01/10/20) *****Attention All Medicaid Providers*****Effective for dates of service on or after January 1, 2020, benefits for vision services non-surgical procedure code 92242 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 800-925-9126.
14 (12/20/19 through 01/24/20) *****Attention All Medicaid Providers*****Effective for dates of service on or after January 1, 2020, magnetic resonance imaging of the fetus, placenta, and maternal pelvic imaging procedure code 74712 will become 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 800-925-9126.
15 (12/27/19 through 01/17/20) *****Attention All Providers*****TMHP will perform system maintenance to the Learning Management System beginning Friday, December 20, through Monday, December 23. Some web-based applications and functions are unavailable during a maintenance outage. For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
16 (12/27/19 through 01/17/20) *****Attention All CSHCN Services Program Providers*****The Claim Appeals for the Children with Special Health Care Needs Services Program computer-based training course has been updated and is now available on the TMHP Learning Management System website. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
17 (12/27/19 through 01/17/20) *****Attention All Medicaid and CSHCN Services Program Providers*****
Effective November 5, 2019, claims with dates of service from January 1, 2018, through November 5, 2019, with procedure code 45388 for surgery and ambulatory surgery center services for Medicaid Qualified Medicare Beneficiary (MQMB) and Children with Special Health Care Needs (CSHCN) Services Program clients must first be submitted to Medicare. Claims submitted with the information above may have been denied in error.Affected claims with dates of service from January 1, 2018, through November 5, 2019, will be reprocessed and providers may receive additional reimbursement, which will be reflected on future Remittance and Status reports.For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
18 (01/03/20 through 01/24/20) *****Attention All CSHCN Services Program Providers*****Effective January 1, 2020, the first quarter 2020 National Correct Coding Initiative updates will be implemented for claims processed by TMHP 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 800-568-2413.
19 (01/03/20 through 01/24/20) *****Attention All Medicaid Providers*****Effective January 1, 2020, the first quarter 2020 National Correct Coding Initiative updates will be implemented for claims processed by TMHP for Texas Medicaid.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
20 (12/27/19 through 01/17/20) *****Attention All Medicaid and CSHCN Services Program Providers*****
Effective for dates of service on or after February 1, 2020, it will no longer be necessary to file claims to Medicare for procedure codes E0637 and E0638 for durable medical equipment purchased new for Medicaid Qualified Medicare Beneficiary (MQMB) and Children with Special Health Care Needs (CSHCN) Services Program clients. Claims submitted for procedure codes E0637 and E0638 for these clients must be submitted to Texas Medicaid for reimbursement instead of Medicare.Additionally, it will no longer be necessary for CSHCN Services Program providers to file claims to Medicare for procedure code E0637 for durable medical equipment rented on a monthly basis. These claims must be submitted to Texas Medicaid.For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
21 (12/27/19 through 01/17/20) *****Attention All Medicaid Providers*****HHSC Leadership has suspended implementation of Rider 43 of the 2018-2019 General Appropriations Act as it applies to providers who utilize the CMS-1450/UB-04 (institutional) claim form. The Rider 43 rendering provider requirements will still apply to physical, occupational, and speech therapy providers who bill on a CMS-1500 (professional) claim form, including groups with performing therapy providers.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
22 (12/27/19 through 01/03/20) *****Attention All Providers*****Wednesday, December 25, 2019, was Christmas Day, a bank holiday. As a result, electronic funds transfer (EFT) payments may be delayed by one business day. Providers that receive EFT payments can expect funds by Monday, December 30, 2019.For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
23 (01/03/20 through 01/24/20) *****Attention All Medicaid Providers*****The Health and Human Services Commission (HHSC) will publish the January semi-annual update of the Medicaid preferred drug list. The preferred drug list and the drug list criteria guide will be effective January 30, 2020.The updates are based on changes presented and recommended at the July and October 2019 Texas Drug Utilization Review Board meetings. Drug list decisions from both meetings are available.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
24 (12/27/19 through 01/17/20) *****Attention All CSHCN Services Program Providers*****Effective February 1, 2020, the Children with Special Health Care Needs (CSHCN) Services Program form titled "CSHCN Services Program Prior Authorization Request for External Insulin Pump," will be renamed "CSHCN Services Program Prior Authorization Request for Diabetic Equipment and Supplies."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.
25 (01/10/20 through 01/31/20) *****Attention All Medicaid and CSHCN Services Program Providers*****
Effective for dates of service on or after February 1, 2020, procedure code 99204 will no longer be denied when billed on the same day by the same provider as procedure code 92250.For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
26 (01/10/20 through 01/31/20) *****Attention All Providers*****The 2020 Healthcare Common Procedure Coding System (HCPCS) additions and deletions that are effective for dates of service on or after January 1, 2020, are now available in the 2020 HCPCS Special Bulletin, No. 17, 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 (CSHCN) Services Program.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
27 (01/10/20 through 01/31/20) *****Attention All Medicaid and Medical Transportation Program Providers*****
The Centers for Medicare & Medicaid Services has published the provider enrollment application fee for calendar year 2020 in the Federal Register. Effective January 1, 2020, the application fee for institutional providers submitting new enrollment applications, revalidation applications, or re-enrollment applications for Texas Medicaid and the Medical Transportation Program will be $595.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
28 (01/10/20 through 01/31/20) *****Attention All Medicaid and CSHCN Services Program Providers*****
TMHP will replay the Provider Revalidation webinar on January 28, 2020. The webinar offers a high-level introduction to the revalidation process using Provider Enrollment on the Portal.The webinar will also cover the streamlined electronic Revalidation application, instructional site hyperlinks, and the message dashboard.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.
29 (01/10/20 through 01/31/20) *****Attention All Medicaid Providers*****Texas Medicaid & Healthcare Partnership (TMHP) has selected two Electronic Visit Verification (EVV) vendors on behalf of the Health and Human Services Commission: DataLogic Software Inc. and First Data Government Solutions. Beginning January 6, 2020, program providers and financial management services agencies (FMSAs) can select one of the two EVV vendors and begin the onboarding process by completing and submitting the EVV Provider Onboarding form, located on each EVV vendor's website.Details are available on the TMHP website at www.tmhp.com. [link]
30 (01/10/20 through 01/31/20) *****Attention All Medicaid Providers*****Texas Medicaid & Healthcare Partnership has updated the paper versions of the Texas Medicaid Provider Enrollment Applications, Medical Transportation Program Provider Application, and the Affordable Care Act Frequently Asked Questions document.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
31 (01/20/20 through 01/31/20) *****Attention All Medicaid Providers*****Effective for dates of service on or after March 1, 2020, diagnosis and gender restrictions for procedure code 81519 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 800-925-9126.
32 (01/10/2020 through 01/31/2020) *****Attention All Early Childhood Intervention Providers*****Effective for dates of service on or after March 1, 2020, telehealth services delivered remotely to children who are eligible for the Early Childhood Intervention (ECI) Program and Medicaid will become a benefit for ECI providers.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
33 (01/20/20 through 01/31/20) *****Attention All Medicaid Providers*****This is a correction to the article titled, "Updated Provider Enrollment Applications and Affordable Care Act Frequently Asked Questions Document Available January 1, 2020," which was published on the TMHP website December 31, 2019.The article announced a document and a list of enrollment applications that were updated on January 1, 2020, including the Enrollment Application for Performing Providers.The Enrollment Application for Performing Providers was not updated on January 1, 2020, and it should not have been included on the list.For more information, call the TMHP Contact Center at 800-925-9126.
34 (01/10/20 through 01/31/20) *****Attention All Medicaid Providers*****Effective for dates of service on or after January 1, 2019, and January 1, 2020, reimbursement rate changes and updates for some procedure codes that were presented at a public rate hearing on Nov. 18, 2019, are now available.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
35 (01/24/20 through 02/14/20) *****Attention All Medicaid Providers*****Beginning March 1, 2020, TMHP will update the Texas Medicaid Provider Procedures Manual, Inpatient and Outpatient Hospital Services Handbook, subsection 4.2.20.2, "Pentamidine Aerosol," to remove
diagnosis restrictions for procedure codes 94642 and J2545. The removal of this subsection will not affect current benefit coverage.For more information, call the TMHP Contact Center at 800-925-9126.
36 (01/17/20 through 01/24/20) *****Attention All Providers*****Monday, January 20, 2020, is Dr. Martin Luther King Jr. Day, which is a bank holiday. As a result, electronic funds transfer (EFT) payments may be delayed by one business day. Providers that receive EFT payments can expect funds by Monday, January 27, 2020.For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
37 (01/24/20 through 02/14/20) *****Attention All Medicaid Providers*****Effective January 16, 2020, for dates of service on or after October 1, 2019, reimbursement rates for procedure code J7314 (Yutiq) and procedure code J7401 (Sinuva) will be updated.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
38 (01/24/20 through 02/14/20) *****Attention All Medicaid Providers*****Effective January 16, 2020, for dates of service on or after October 1, 2019, reimbursement rates for procedure code J7314 (Yutiq) and procedure code J7401 (Sinuva) will be updated.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
39 (01/31/20 through 02/21/20) *****Attention All SHARS Providers*****Effective for dates of service on or after January 1, 2020, counseling and psychological services procedure codes 96152 and 96153 were discontinued by the 2020 annual Healthcare Common Procedure Coding System 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 800-925-9126.
40 (01/24/20 through 03/27/20) *****Attention All Medicaid Providers*****Texas Medicaid & Healthcare Partnership (TMHP) has selected two Electronic Visit Verification (EVV) vendors on behalf of the Health and Human Services Commission (HHSC): DataLogic Software Inc., and First Data Government Solutions.EVV vendor webinars and roadshows have been scheduled to demonstrate the EVV vendor systems, and will include question and answer (Q&A) sessions. Details, including registration information, are available on the EVV webpage of the TMHP website at www.tmhp.com. [link]For more information, contact [email protected].
41 (02/07/20 through 02/28/20) *****Attention All Medicaid Providers*****Beginning January 1, 2020, Substance Abuse and Mental Health Services Administration certified opioid treatment providers (OTPs) are required to enroll in Medicare and re-enroll with Texas Medicaid as OTPs to bill Medicare as the primary payer.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
42 (02/07/20 through 02/28/20) *****Attention All Medicaid Providers*****The Vendor Drug Program will implement the Rinvoq (Upadacitinib) clinical prior authorization criteria on March 3, 2020.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
43 (02/07/20 through 02/28/20) *****Attention All Medicaid Providers*****The Vendor Drug Program will modify the Austedo prior authorization criteria on March 3, 2020.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
44 (02/07/20 through 02/28/20) *****Attention All Medicaid Providers*****The Vendor Drug Program will revise the Allergen Extracts clinical prior authorization criteria on February 24, 2020. This change reflects the U.S. Food and Drug Administration guidance expanding the indication for Oralair for people 5 years of age and older.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
45 (02/07/20 through 02/28/20) *****Attention All Medicaid Providers*****The quarterly 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]For more information, call the TMHP Contact Center.
46 (02/07/20 through 02/28/20) *****Attention All Medicaid Providers*****The Crossover Claims computer-based training course has been updated and is available on the TMHP Learning Management System (LMS) website. [link]Details are available on the TMHP website at www.tmhp.com.For more information, call the TMHP Contact Center at 800-925-9126.
47 (02/14/20 through 03/06/20) *****Attention Early Childhood Intervention Providers*****There is a correction to an article titled "Telehealth Services Will Become a Benefit for Early Childhood Intervention Providers Effective March 1, 2020," which was published on the TMHP website on January 6, 2020.
Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
48 (01/31/20 through 03/06/20) *****Attention All Medicaid Providers*****Beginning February 1, 2020, updates to Electronic Visit Verification (EVV) Portal Standard Reports will be available for all EVV Portal users. Additionally, managed care organization (MCO)-only enrolled program providers can use TexMedConnect to submit batch claims for EVV.Details are available on the TMHP website at www.tmhp.com. [link]For more information, contact [email protected] or call the EDI Help Desk at 888-863-3638, Option 4.
49 (01/31/20 through 03/06/20) *****Attention All Medicaid Providers*****By April 1, 2020, program providers and financial management services agencies (FMSAs) required to use Electronic Visit Verification (EVV) in accordance with the 21st Century Cures Act Section 12006 (Cures Act) must select an EVV vendor from the state pool or elect to use an EVV proprietary system and submit the appropriate forms to begin the onboarding process.Details are available on the TMHP website at www.tmhp.com. [link]For more information, contact [email protected].
50 (02/14/20 through 03/06/20) *****Attention All Medicaid Providers*****Effective for dates of service on or after March 1, 2020, benefit information for medication assisted treatment services 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 800-925-9126.
51 (02/14/20 through 03/06/20) *****Attention All Medicaid Providers*****There is a correction to the 2020 Healthcare Common Procedure Coding System Special Bulletin, No. 17, which was published on the TMHP website December 31, 2019.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
52 (02/14/20 through 03/06/20) *****Attention All Medicaid and CSHCN Services Program Providers*****
If a provider or a client discontinues service during an existing prior authorized period and the client requests services through a new provider with a Change of Provider letter, a change of provider during an authorization period will not extend the current authorization period.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
53 (02/14/20 through 03/06/20) *****Attention All Medicaid Providers*****The deadline to participate in program year 2019 of the Texas Medicaid Electronic Health Record (EHR) Incentive/Promoting Interoperability (PI) Program is February 29, 2020. Deadlines that are missed cannot be appealed.For more information go to https://healthit.hhsc.texas.gov/ehr-incentivepi-program-attestation-deadline-2019-february-29-2020.Details are available on the TMHP website at www.tmhp.com. [link]
54 (02/21/20 through 03/13/20) *****Attention All CSHCN Services Program Providers*****On April 1, 2020, TMHP will implement the first quarter 2020 Healthcare Common Procedure Coding System additions, revisions, and discontinuations, which will be effective for dates of service on or after April 1, 2020. 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.
55 (02/21/20 through 03/13/20) *****Attention All CSHCN Services Program Providers*****Effective for dates of service on or after April 1, 2020, procedure code 90650 will no longer be a benefit of the Children with Special Health Care Needs (CSHCN) Services Program.For more information, call the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
56 (02/21/20 through 03/13/20) *****Attention All Medicaid Providers*****On April 1, 2020, TMHP will implement the first quarter 2020 Healthcare Common Procedure Coding System (HCPCS) additions, revisions, and discontinuations, which will be effective for dates of service on or after April 1, 2020. Discontinued procedure codes will no longer be considered as 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 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.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
57 (02/21/20 through 03/13/20) *****Attention All Medicaid and CSHCN Services Program Providers*****
Effective April 1, 2020, Taxonomy Code descriptions will be updated for some Respiratory, Developmental, Rehabilitative, and Restorative Services provider types 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 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
58 (02/14/20 through 02/21/20) *****Attention All Providers*****Monday, February 17, 2020, is Presidents' Day, which is a bank holiday. As a result, electronic funds transfer (EFT) payments may be delayed by one business day. Providers that receive EFT payments can expect funds by Monday, February 24, 2020.For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
59 (02/21/20 through 03/13/20) *****Attention All Medicaid Providers*****Effective for claims submitted on or after February 29, 2020, American Dental Association claims electronically submitted to TMHP for STAR Health (Foster Care) dental services will be rejected.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
60 (02/21/20 through 03/13/20) *****Attention All Medicaid Providers*****This is an update to an article titled "Benefit Changes for Gene Expression Profiling Procedure Code 81519 Effective March 1, 2020," which was published on the TMHP website on January 10, 2020.Changes to diagnosis and gender restrictions for procedure code 81519 previously scheduled for implementation March 1, 2020, are on hold pending further review. Additional information regarding these updates will be provided as it becomes available. For more information, call the TMHP Contact Center at 800-925-9126.
61 (02/21/20 through 03/13/20) *****Attention All Medicaid Providers*****Effective for dates of service on or after April 1, 2020, chemistry procedure codes used for specimen validity testing (procedure codes 82540, 82550, 82552, 82553, 82554, 83986, and 84311) will be denied when submitted on the same date of service by the same provider, as procedure code G0480, G0481, G0482, G0483, or G0659.For more information, call the TMHP Contact Center at 800-925-9126.
62 (02/21/20 through 03/20/20) *****Attention All Healthy Texas Women Providers*****Effective February 18, 2020, Texas will begin receiving federal financial participation for the Healthy Texas Women program, excluding services provided to clients ages 15 through 17.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
63 (02/28/20 through 03/20/20) *****Attention All Medicaid Providers*****Texas Medicaid & Healthcare Partnership (TMHP) has updated the Electronic Visit Verification (EVV) Portal Standard Reports and Search Tools job aid, and the TMHP computer-based training (CBT) Module 5: EVV Portal Standard Reports and Search Tools. These updates reflect the November 22, 2019 EVV Portal enhancements to search tools.Details are available on the EVV webpage of the TMHP website at www.tmhp.com. [link]
64 (02/28/20 through 03/20/20) *****Attention All Medicaid Providers*****New documents about the Electronic Visit Verification (EVV) Proprietary System Onboarding Process are available on the Texas Medicaid & Healthcare Partnership (TMHP) EVV Proprietary Systems webpage.Details are available on the TMHP website at www.tmhp.com. [link]For more information, contact [email protected].
65 (02/28/20 through 03/20/20) *****Attention All Medicaid Providers*****Reminder: Mylan issued an alert regarding the manufacturing challenges in the production of EpiPen (epinephrine injection, USP) 0.3 mg and EpiPen Jr (epinephrine injection, USP) 0.15 mg auto-injectors and the authorized generic versions of these strengths. These challenges resulted in the reduced availability of these products.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
66 (02/28/20 through 03/20/20) *****Attention All Medicaid Providers*****The Texas Drug Utilization Review (DUR) Board met January 4, 2020, to make recommendations for Medicaid clinical prior authorizations and the preferred drug list. A summary of this meeting is now available from 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 800-925-9126.
67 (02/28/20 through 03/20/20) *****Attention All Medicaid Providers*****The quarterly update to the Pharmacy Clinical Prior Authorization Assistance Chart is now available.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
68 (02/28/20 through 03/20/20) *****Attention All Medicaid Providers*****The Vendor Drug Program will implement the Growth Hormone clinical prior authorization criteria on April 17, 2020, for traditional Medicaid.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
69 (02/28/20 through 03/20/20) *****Attention All Medicaid and CSHCN Services Program Providers*****
Reminder: Providers that need to change or add information on a prior authorization request form must strike through the incorrect information with a single line. The original content must remain legible, and the change must be initialed and dated by the original signatory or ordering physician, when applicable. Changes made using a correction fluid (e.g., Wite-Out) will not be accepted.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
70 (03/06/20 through 03/27/20) *****Attention All Medicaid Providers*****Reminder: Beginning January 1, 2020, Substance Abuse and Mental Health Services Administration certified opioid treatment providers (OTPs) are required to enroll in Medicare and re-enroll with Texas Medicaid as an OTP to bill Medicare as the primary payer.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
71 (02/28/20 through 03/20/20) *****Attention All Medicaid Providers*****Beginning March 1, 2020, TMHP will update the Texas Medicaid Provider Procedures Manual, Vol. 1, General Information, Provider Enrollment and Responsibilities, subsection 1.1.9.11, "Copy of License and Temporary License or Certification" to add an automated system for handling provider licensure information to cover certified registered nurse anesthetist, nurse practitioner, ophthalmologist, and physical therapy providers.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
72 (02/28/20 through 03/20/20) *****Attention All CSHCN Services Program Providers *****Effective for dates of service on or after March 1, 2020, reimbursement rates for some 2019 first quarter and second quarter Healthcare Common Procedure Coding System (HCPCS) procedure codes for the Children with Special Health Care Needs (CSHCN) Services Program will implement.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
73 (03/06/20 through 03/27/20) *****Attention All Medicaid Providers*****The Vendor Drug Program will implement the Trikafta criteria within the existing Cystic Fibrosis Agents clinical prior authorization on February 24, 2020. Details are available on the TMHP website at www.tmhp.com. [link]
74 (03/06/20 through 03/27/20) *****Attention All Medicaid Providers *****The Texas Health and Human Services Commission is accepting applications from new candidates for the Medicaid Electronic Health Record Incentive Promoting Interoperability Program Informal Audit Ad Hoc Review Panel. Interested candidates should submit a completed application no later than 11:59 p.m. on March 6, 2020.For more information or questions, email [email protected].
75 (03/06/20 through 03/27/20) *****Attention All Medicaid Providers*****There is a correction to the article titled "Allergy Testing Evaluation and Management Limitation Language Updated," that was published on the TMHP website on December 13, 2019.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
76 (03/13/20 through 04/10/20) *****Attention All Medicaid Providers*****By April 1, 2020, program providers and financial management services agencies (FMSAs) subject to 21st Century Cures Act Electronic Visit Verification (EVV) requirements must select an EVV vendor or elect to use their own EVV proprietary system and submit the appropriate form to begin the onboarding process.Details are available on the TMHP website at www.tmhp.com. [link]For more information, contact [email protected].
77 (03/06/20 through 03/27/20) *****Attention All Medicaid Providers*****Effective for dates of service on or after April 1, 2020, clarification language will be added to the Respiratory Equipment and Supplies - Home Health Texas Medicaid medical policy to distinguish the difference between back-up and replacement ventilators.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
78 (03/20/20 through 04/10/20) *****Attention All Healthy Texas Women Providers *****The Texas Health and Human Services Commission is encouraging providers of the Healthy Texas Women program to connect clients with the Primary Health Care (PHC) program when they may no longer be eligible for HTW.Details are available on the TMHP website at www.tmhp.com. [link]For any questions or concerns regarding this matter, or for more information about the PHC program, send an email to [email protected] or contact the office at 512-776-3317.
79 (03/13/20 through 04/03/20) *****Attention All CSHCN Services Program Providers*****Effective for dates of service on or after April 1, 2020, TMHP will update the Children with Special Health Care Needs (CSHCN) Services Program Provider Manual, Physician chapter, section 31.2.18.9.5, "Developmental Screening," to clarify developmental screening and testing procedure codes 96110 and procedure code 96110 with modifier U6 benefit criteria.For more information, call the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
80 (03/20/20 through 04/10/20) *****Attention All Medicaid Providers*****Beginning May 1, 2020, Medicare-enrolled speech-language pathologists (SLPs) may apply to enroll as Texas Medicaid providers through TMHP. After enrollment, each SLP will be assigned a new SLP provider identifier. The SLP provider identifier will enable the SLP to bill for services to clients of all ages, including those who are Medicare-Medicaid dual eligible. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
81 (3/20/20 through 04/10/20) *****Attention All Medicaid Providers *****TMHP will update the paper versions of the Texas Medicaid Provider Enrollment Applications.Effective May 1, 2020, the paper Texas Medicaid Provider Enrollment Applications and Instructions for Groups, Performing Providers, and Individuals for Traditional Services will include Speech-Language Pathologist (SLP).
Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
82 (03/20/20 through 04/10/20) *****Attention All Medicaid Providers*****Effective September 1, 2019, new state legislation mandates increased syphilis testing in pregnant women to be administered at the first prenatal care examination, during the third trimester, and at delivery.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
83 (03/20/20 through 04/10/20) *****Attention All Medicaid Providers*****Effective October 1, 2019, if any discrepancies are identified between the Social Security number (SSN) listed on the enrollment application and any associated Texas Provider Identifiers (TPIs) for the enrolling provider, a copy of the provider's Social Security card is required to confirm the identity of the enrolling provider.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
84 (03/20/20 through 04/10/20) *****Attention All Medicaid Providers*****Effective for dates of service on or after January 1, 2020, reimbursement rate changes and updates for Annual Healthcare Common Procedure Coding System (HCPCS) procedure codes that were presented at a public rate hearing on January 28, 2020, will be implemented. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
85 (03/20/20 through 04/10/20) *****Attention All Medicaid Providers *****Effective for dates of service on or after January 1, 2020, physicians and other qualified health-care professionals under physician delegation are not required to submit claims to Medicare for procedure codes 99421, 99422, and 99423, for services rendered to clients who have dual eligibility for Medicaid and Medicare, for disposition prior to submitting the claims to Texas Medicaid.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
86 (03/13/20 through 04/03/20) *****Attention All Medicaid Providers*****Effective for dates of service on or after April 1, 2020, therapeutic continuous glucose monitors will be a benefit of Texas Medicaid through Title XIX Home Health Services.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
87 (03/20/20 through 04/10/20) *****Attention All Medicaid Providers *****The Texas Health and Human Services Commission is accepting applications from new candidates for the Medicaid Electronic Health Record Incentive Promoting Interoperability Program Informal Audit Ad Hoc
Review Panel. The deadline has been extended, and interested candidates should submit a completed application no later than 11:59 p.m. on March 31, 2020.For more information or questions, email [email protected].
88 (03/20/20 through 04/10/20) *****Attention Medicaid Providers*****In an effort to promote women's health, Texas Health and Human Services is raising awareness of long-acting reversible contraception.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
89 (03/27/20 through 04/17/20) *****Attention All CSHCN Services Program Providers*****Effective April 1, 2020, the second quarter 2020 National Correct Coding Initiative updates will be implemented for claims processed by TMHP 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 800-568-2413.
90 (03/27/20 through 04/17/20) *****Attention All Medicaid Providers*****By April 1, 2020, program providers and financial management services agencies subject to 21st Century Cures Act Electronic Visit Verification (EVV) requirements must select an EVV vendor or elect to use their own EVV proprietary system and submit the appropriate form to begin the onboarding process. Note: The onboarding process for an EVV vendor or EVV proprietary system does not need to be complete by April 1, 2020. Details are available on the TMHP website at www.tmhp.com. [link]For more information, contact [email protected].
91 (03/27/20 through 04/17/20) *****Attention All Medicaid Providers*****Effective for dates of service on or after April 1, 2020, percutaneous liver biopsy (procedure code 47000) will be reimbursed when rendered in the office setting. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
92 (03/27/20 through 04/17/20) *****Attention All Medicaid Providers*****Effective March 12, 2020, for dates of service on or after January 1, 2020, the reimbursement rate for procedure code Q5107 Mvasi (Bevacizumab) will be updated. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
93 (03/20/20 through 04/03/20) *****Attention All Providers*****Reminder: Providers may provide telecommunication services for Texas Medicaid clients under the provider's Texas Medicaid provider identifier. No additional enrollment is required to provide telemedicine medical services or telehealth services.
Details are available on the TMHP website at tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
94 (03/20/20 through 04/17/20) *****Attention All Medicaid Providers*****Reminder: Providers must complete their revalidation enrollment before the end of their enrollment period. Providers can revalidate their enrollment up to 90 days before their deadlines through Provider Enrollment on the Portal, available on the TMHP website. Providers who are unable to revalidate online must download and submit the appropriate paper enrollment application.Providers who do not complete the revalidation process by their deadlines will be disenrolled from all Texas state health-care programs; claims and prior authorization requests will be denied.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
95 (03/27/20 through 04/17/20) *****Attention All Medicaid Providers*****Effective April 1, 2020, the second quarter 2020 National Correct Coding Initiative updates will be implemented for claims processed by TMHP for Texas Medicaid.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
96 (03/27/20 through 04/17/20) *****Attention All Medicaid and CSHCN Services Program Providers*****
On March 12, 2020, TMHP began implementing the first quarter 2020 Healthcare Common Procedure Coding System (HCPCS) additions, which includes coronavirus testing procedure codes U0001 and U0002.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
97 (03/27/20 through 04/17/20) *****Attention All Providers*****Effective for dates of discharges on or after April 1, 2020, Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program will use version 37.1 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]For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
98 (03/27/20 through 04/10/20*****Attention All Medicaid Providers*****Effective immediately, Federally Qualified Health Centers may be reimbursed as telemedicine (physician delivered) or telehealth (non-physician-delivered) service distant site providers.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
99 (04/03/20 through 04/24/20) *****Attention All CSHCN Services Program Providers*****Effective for dates of service on or after April 1, 2020, chemistry procedure codes used for specimen validity testing (procedure codes 82540, 82550, 82552, 82553, 82554, 83986, and 84311) will be denied when submitted on the same date of service by the same provider, as procedure code G0480, G0481, G0482, G0483, or G0659.For more information, call the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
100 (04/03/20 through 03/24/20) *****Attention All CSHCN Services Program Providers *****The Children with Special Health Care Needs (CSHCN) Services Program has introduced the CSHCN Topic Nomination Form for requesting that the CSHCN Services Program consider coverage or expansion of a possible benefit. Members of the public, state agencies, and others should submit requests using this form.For more information, call the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
101 (04/03/20 through 04/24/20) *****Attention All CSHCN Services Program Providers*****There is an update to the article titled, "HPV2 No Longer a Benefit for the CSHCN Services Program Effective April 1, 2020," which was published on the TMHP website February 14, 2020.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
102 (03/27/20 through 04/10/20) *****Attention All CSHCN Services Program Providers*****Effective for dates of service on or after May 1, 2020, office and outpatient services limitation language will be added to the Physician Evaluation and Management Services medical policy 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 800-568-2413.
103 (04/03/20 through o4/24/20) *****Attention All CSHCN Services Program Providers *****Effective for dates of service on or after April 1, 2020, reimbursement rate updates for some Drug Testing Assays procedure codes for the Children with Special Health Care Needs (CSHCN) Services Program will implement.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
104 (03/20/20 through 04/10/20) *****Attention All Medicaid Providers*****Contracted provider groups, independent physician groups, and physician management companies that have a hospital-based practice location must ensure that the organization's contact information is listed as the accounting or mailing address rather than the hospital's information. Providers can check this information in Provider Information Management System.Having the organization's contact information listed as the accounting or mailing address will ensure that all applicable communications are sent to the provider group rather than the hospital utilizing the contracted provider services.
For more information, call the TMHP Contact Center at 800-925-9126.
105 (03/27/20 through 04/10/20) *****Attention All Medicaid Providers *****To help ensure continuity of care during the COVID-19 (coronavirus) response, HHSC is authorizing providers to bill for telephone (audio only) medical (physician delivered) evaluation and management services delivered on March 20, 2020, through April 30, 2020. Providers should continue to use the 95 modifier to indicate that remote delivery has occurred.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
106 (03/27/20 through 04/17/20) *****Attention All Medicaid Providers*****To help ensure continuity of care during the COVID-19 (coronavirus) response, HHSC is authorizing providers to submit claims for dates of service March 20, 2020, through April 30, 2020, for reimbursement of the following behavioral health services delivered by telephone (audio only): Psychiatric Diagnostic Evaluation, Psychotherapy, Peer Specialist Services, Screening, Brief Intervention and Referral to Treatment, Substance Use Disorder Services, and Mental Health Rehabilitation Services.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
107 (04/03/20 through 04/24/20) *****Attention All HTW and Family Planning Program Providers*****
Effective April 1, 2020, coronavirus (COVID-19) testing procedure codes U0001 and U0002 will be a benefit of the Healthy Texas Women program and the state-funded Family Planning Program for dates of service on or after February 4, 2020.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
108 (04/03/20 through 04/24/20) *****Attention All Medicaid and Family Planning Program Providers*****
Effective for dates of service on or after April 1, 2020, reimbursement rate changes and updates for procedure codes that were presented at a public rate hearing on February 21, 2020, will be implemented.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
109 (04/03/20 through 04/24/20) *****Attention All Medicaid Providers*****In response to the novel coronavirus (COVID-19), the Health and Human Services Commission (HHSC) issued temporary Electronic Visit Verification (EVV) policies for existing EVV users. HHSC is also extending the deadline for selecting an EVV vendor or EVV proprietary system to May 1, 2020 for program providers and financial management services agencies (FMSAs) impacted by the Cures Act.Details are available on the TMHP website at www.tmhp.com. [link]For more information, contact [email protected].
110 (04/03/20 through 04/10/20) *****Attention All Medicaid Providers*****Texas Medicaid added new exception criteria to the January 24, 2020, Preferred Drug List to check for a diagnosis of stage 4 advanced metastatic cancer, or for treatment of symptoms associated with the cancer diagnosis.For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
111 (04/03/20 through 04/24/20) *****Attention All Medicaid Providers*****There is an update to the article titled "HPV2 and HPV4 No Longer Available Through TVFC Program," which was published on the TMHP website June 10, 2016.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
112 (03/27/20 through 04/10/20) *****Attention All Medicaid and CSHCN Services Program Providers*****
Effective for dates of service on or after May 1, 2020, TMHP will update the Texas Medicaid Provider Procedures Manual, Medical and Nursing Specialists, Physicians, and Physicians Assistants Handbook, section 5.2.5, "Genetic Evaluation and Counseling by a Geneticist," and the Children with Special Health Care Needs (CSHCN) Services Program Provider Manual, Physician chapter, section 31.2.22, "Genetics," to clarify reimbursement criteria for procedure codes 99254 and 99255, which only allows one of the procedure codes to be paid every three years.For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
113 (04/03/20 through 04/24/20) *****Attention All Medicaid Providers*****Texas Medicaid is conducting a utilization review of inpatient claims with dates of service from February 05, 2018 through January 23, 2020 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 800-925-9126.
114 (04/03/20 through 04/24/20) *****Attention All Medicaid Providers*****On March 31, 2020, TMHP will implement the first quarter 2020 Healthcare Common Procedure Coding System additions, revisions, and discontinuations, which will be effective for dates of service on or after April 1, 2020.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
115 (04/03/20 through 04/24/20) *****Attention All CSHCN Services Program Providers*****On March 31, 2020, TMHP will implement the first quarter 2020 Healthcare Common Procedure Coding System additions, revisions, and discontinuations, which will be effective for dates of service on or after April 1, 2020.
Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
116 (04/03/20 through 04/10/20) *****Attention All Healthy Texas Women and Family Planning Program Providers*****
To help ensure continuity of care during the COVID-19 (coronavirus) response, effective March 1, 2020, some procedure codes, when billed with the 95 modifier, will be a benefit for distant-site telemedicine and telehealth providers in Healthy Texas Women (HTW) and Family Planning Program (FPP) through April 30, 2020.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
117 (03/27/20 through 04/10/20) *****Attention All Medicaid Providers*****TMHP is committed to helping providers ensure continuity of care during the COVID-19 (coronavirus) response. To alleviate the work and eliminate the wait for paper prior authorizations (PA) and claims, providers are encouraged to transition from paper to electronic PA submission and claims billing using TMHP's free and secure electronic systems.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
118 (04/03/20 through 04/24/20) *****Attention CSHCN Services Program Home Health Providers*****
The Texas Department of State Health Services has issued new recommendations for the use of personal protective equipment (PPE). Please refer to the guidelines at DSHS Information on PPE.For more information, call the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
119 (04/03/20 through 04/24/20) *****Attention All Durable Medical Equipment Providers*****To help ensure continuity of care during the COVID-19 (coronavirus) response, effective immediately, the requirement to obtain the client or guardian signature on the DME Certification and Receipt Form is waived through April 30, 2020. For more information, call the TMHP Contact Center at 800-925-9126.
120 (04/03/20 through 04/24/20) *****Attention All Durable Medical Equipment Providers*****To help ensure continuity of care during the COVID-19 (coronavirus) response, effective immediately, the requirement to obtain the client or guardian signature on the CSHCN Services Program Documentation of Receipt Form is waived through April 30, 2020. For more information, call the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
121 (04/10/20 through 05/01/20) *****Attention All Medicaid and CSHCN Services Program Providers*****
Effective for dates of service on or after May 1, 2020, the limitation for procedure code 87798 will increase from one per day to three per day by the same provider.
For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
122 (04/03/20 through 04/24/20) *****Attention All Medicaid and CSHCN Services Program Providers*****
Effective July 1, 2019, TMHP has contracted with Trend Health Partners to perform credit balance and recovery audits.Trend Health Partners is an employee-owned health-care consulting firm that assists with the resolution of credit balances and recovering overpayments on behalf of Texas Medicaid. Trend will review any current accounts with a credit balance status where both TMHP and a health insurance carrier made a primary or secondary payment for services in which the health insurance carrier was liable for payment before Medicaid.For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
123 (04/10/20 through 05/01/20) *****Attention All Medicaid Providers*****The Vendor Drug Program will implement clinical prior authorization criteria for Sunosi (solriamfetol) for traditional Medicaid on April 14, 2020. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
124 (04/03/20 through 05/01/20) *****Attention All Medicaid Providers *****Case management may be delivered through synchronous audio-visual technologies or telephone (audio-only). Providers should bill procedure code T1017 using the 95 modifier to indicate that remote delivery occurred.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
125 (04/10/20 through 05/01/20) *****Attention Texas Health Steps Providers*****Texas Health Steps recognizes the critical importance of routine preventive medical and dental checkups for Texas children. However, during this challenging time, Texas Health Steps encourages medical and dental providers to make decisions on adjusting their clinical operations based on their professional medical judgement and/or guidance from their professional medical and dental societies. This should include considering the risk of exposure to COVID-19 (coronavirus) at the local and community level.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
126 (04/10/20 through 05/01/20) *****Attention All Medicaid and CSHCN Services Program Providers*****
The Centers for Disease Control and Prevention's National Center for Health Statistics is implementing a new diagnosis code into the International Classification of Diseases, Tenth Revision, Clinical Modification, for reporting Novel Coronavirus Disease, COVID-19
Effective April 1, 2020, for dates of service on or after February 20, 2020, diagnosis code U071 will be a benefit of Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program for reporting Novel Coronavirus Disease, COVID-19.For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
127 (03/27/20 through 04/17/20) *****Attention All Medicaid and CSHCN Services Program Providers*****
Due to the COVID-19 disaster, effective March 1, 2020, providers not enrolled with Texas Medicaid or the CSHCN Services Program can expedite the enrollment process by using the Texas Medicaid Health Emergency Enrollment Application. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
128 (04/03/20 through 04/24/20) *****Attention All Medicaid Providers*****On March 21, 2020, the Vendor Drug Program changed the preferred drug list status of certain Albuterol products from non-preferred to preferred. This is a temporary change to address reported drug shortages for short-acting agents in the bronchodilators, beta agonist drug class.Details are available on the TMHP website at www.tmhp.com. [link]
129 (04/10/20 through 05/01/20) *****Attention All Medicaid and CSHCN Services Program Providers *****
The "Top 5 Ways to Make the Provider Enrollment Application Easy" instructional video is available for viewing.This short video explains the five most common Provider Enrollment Application deficiencies, and how to avoid them.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
130 (04/10/20 through 05/01/20) *****Attention All Medicaid Providers *****To help rural health clinics deliver care to clients in response to COVID-19 (coronavirus), RHCs may be reimbursed as telemedicine and telehealth distant site providers statewide for service dates from March 24, 2020, through April 30, 2020. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
131 (04/10/20 through 05/01/20) *****Attention All Medicaid and CSHCN Services Program Providers*****
In response to the current COVID-19 public health emergency, provider revalidation due dates will be extended 30 calendar days to prevent provider disenrollment. Providers can view the revalidation status on the Provider Information Management System (PIMS).
Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
132 (04/10/20 through 05/01/20) *****Attention All Medicaid Providers *****To help ensure continuity of care during the COVID-19 (coronavirus) response, HHSC has directed TMHP to extend by 90 days existing prior authorizations that require recertification and are set to expire March 13, 2020, through April 30, 2020.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
133 (04/10/20 through 05/01/20) *****Attention All Medicaid and CSHCN Services Program Providers*****
Due to the COVID-19 disaster, effective March 1, 2020, providers not enrolled with Texas Medicaid or the CSHCN Services Program can expedite the enrollment process by using the Texas Medicaid Health Emergency Enrollment Application.Providers who apply with the Public Health Emergency Application are automatically enrolled into both Texas Medicaid and the CSHCN Services Program unless they opt out of one, as prompted in the application.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
134 (04/10/20 through 04/17/20) *****Attention All Providers*****Electronic funds transfer (EFT) payments may be delayed by one business day due to a payment processing issue that has been resolved at the Health and Human Services Commission. Providers that receive EFT payments can expect funds by Monday, April 6, 2020, at the latest.For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
135 (04/10/20 through 05/01/20) *****Attention All CSHCN Services Program Providers *****To help ensure continuity of care during the COVID-19 (coronavirus) response, the Children with Special Health Care Needs (CSHCN) Services Program will begin reimbursing federally qualified health centers and rural health clinics as telemedicine (physician-delivered) and telehealth (non-physician delivered) service distant site providers statewide for service dates from March 24, 2020, through April 30, 2020.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
136 (04/10/20 through 05/01/20) *****Attention All CSHCN Services Program Providers *****To help ensure continuity of care during the COVID-19 (coronavirus) response, Children with Special Health Care Needs (CSHCN) Services Program is authorizing providers to bill for telephone (audio only) medical (physician delivered) evaluation and management services delivered on March 20, 2020, through
April 30, 2020. Providers should continue to use the 95 modifier to indicate that remote delivery has occurred. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
137 (04/10/20 through 05/01/20) *****Attention All CSHCN Services Program Providers *****To help ensure continuity of care during the COVID-19 (coronavirus) response, the Children with Special Health Care Needs (CSHCN) Services Program is authorizing providers to submit claims for dates of service March 20, 2020, through April 30, 2020, for reimbursement of the following behavioral health services delivered by telephone (audio only): Psychiatric Diagnostic Evaluation, Psychotherapy, Peer Specialist Services, Screening, Brief Intervention and Referral to Treatment, Substance Use Disorder Services, and Mental Health Rehabilitation 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 800-568-2413.
138 (04/10/20 through 05/01/20) *****Attention All Medicaid and CSHCN Services Program Providers*****
Effective April 1, 2020, some laboratory procedure codes will be subject to Clinical Laboratory Improvement Amendments (CLIA) certification.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
139 (04/10/20 through 05/01/20) *****Attention All CHIP Providers*****The Health and Human Services Commission has released guidance on updates to the collection of Children's Health Insurance Program (CHIP) office visit co-payments by CHIP providers.Details and a link to the CHIP co-payment guidelines are available on the TMHP website. [link]
140 (04/10/20 through 05/01/20) *****Attention All Medicaid Providers *****There is a correction to the article titled "COVID-19 Guidance: Targeted Case Management Through Remote Delivery," which was posted on the TMHP website on April 1, 2020.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
141 (04/10/20 through 05/01/20) *****Attention All Medicaid Providers*****On April 1, 2020, the Federal Drug Administration requested that manufacturers withdraw all ranitidine products (commonly known by the brand name Zantac) from the market because of consumer exposure to unacceptable levels of impurities.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
142 (04/10/20 through 05/01/20) *****Attention all HTW and FPP Providers*****To help ensure continuity of care during the COVID-19 (coronavirus) response, Healthy Texas Women will begin reimbursing federally qualified health centers (FQHCs) and rural health clinics as telemedicine (physician-delivered) and telehealth (non-physician delivered) service distant site providers statewide for service dates from March 24, 2020, through April 30, 2020. The Family Planning Program will begin reimbursing FQHCs as telemedicine (physician-delivered) and telehealth (non-physician delivered) service distant site providers statewide for service dates from March 24, 2020, through April 30, 2020.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
143 (04/10/20 through 05/08/20) *****Attention All Medicaid Providers *****There is an update to the article titled, "Prior Authorization Requests Extended Due to COVID-19 Public Health Emergency," which was posted on the TMHP website on March 31, 2020.The update is that the extended prior authorizations (PAs) have been expanded to include PAs due for recertification between March 1, 2020, through May 31, 2020.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
144 (04/17/20 through 05/08/20) *****Attention All Medicaid Providers*****There is an update to an article titled 'Implementation on hold for 'Benefit Changes for Gene Expression Profiling Procedure Code 81519,' which was published on the TMHP website on February 11, 2020.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
145 (04/17/20 through 05/08/20) *****Attention All Providers*****There is an update to the article titled, "TMHP to Use Grouper Version 37.1 for Dates of Discharge on or after April 1, 2020," that was published on the TMHP website on March 18, 2020.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
146 (04/17/20 through 05/08/20) *****Attention SHARS Providers*****Under Governor Abbott's Executive Order GA-14 dated March 31, 2020, "schools shall remain temporarily closed to in-person classroom attendance and shall not recommence before May 4, 2020." However, schools may continue to provide instruction using alternative methods of delivery. If a school that participates in the School and Health Related Services (SHARS) program provides instruction to a Medicaid-eligible student during this time, the school may seek Medicaid reimbursement for SHARS services delivered through telemedicine or telehealth, assuming all other SHARS program requirements are met.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
147 (04/24/20 through 05/15/20) *****Attention All Medicaid Providers *****Beginning June 1, 2020, Medicare-enrolled speech-language pathologists (SLPs) who have been assigned a new SLP provider identifier will be eligible to bill Medicaid for SLP services for clients of all ages, including those who are Medicare-Medicaid dual eligible.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
148 (04/24/20 through 05/15/20) *****Attention All Medicaid and CSHCN Service Program Providers*****
There is an update to the article titled, "Provider Enrollment Revalidation Due Dates Extended in Response to COVID-19 Emergency," which was published on the TMHP website on April 1, 2020. Details are available at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
149 (04/24/20 through 05/15/20) *****Attention All Medicaid and CSHCN Services Program Providers*****
There is a correction to the article titled "New COVID-19 Diagnosis Code U071 to Be a Benefit of Texas Medicaid and the CSHCN Services Program Effective April 1, 2020," that was published on this website on March 27, 2020.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
150 (04/24/20 through 05/15/20) *****Attention All Medicaid Providers *****The Prior Authorization (PA) on the Portal Testimonial video is available for viewing.This short video explains the benefits of using PA on the Portal from a provider's perspective.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
151 (04/17/20 through 05/08/20) *****Attention All Medicaid and CSHCN Service Program Providers*****
All new enrollment, revalidation, and re-enrollment applications submitted on or after March 1, 2020, and before the end of the federally-approved public health emergency will be exempt from the requirements to submit proof of fingerprinting and undergo pre-enrollment and post-enrollment site visits (as applicable to the provider type).Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
152 (04/24/20 through 05/15/20) *****Attention All Medicaid Providers*****Effective for dates of service March 15, 2020, through April 30 2020, authorized occupational, physical, and speech therapy for clients of all ages may be delivered as a telehealth service.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
153 (04/24/20 through 05/15/20) *****Attention All Medicaid Providers*****The Vendor Drug Program temporarily revised the preferred drug list on April 1, 2020, to address reported possible drug shortages of products in the inhaled glucocorticoid and hypoglycemic insulin drug classes.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
154 (04/24/20 through 05/15/20) *****Attention All Medicaid and CSHCN Services Program Providers*****
Beginning May 29, 2020, revenue codes will be included on 277CA Claims Acknowledgement files.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
155 (04/24/20 through 05/15/20) *****Attention All Medicaid Providers*****There is a correction to the article titled "Reimbursement Rate Changes Presented at Public Rate Hearing on January 28, 2020, to Be Effective January 1, 2020" that was published on the TMHP website on March 9, 2020.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
156 (04/24/20 through 05/15/20) *****Attention All Medicaid Providers*****May 1, 2020, is the deadline for Electronic Visit Verification (EVV) program providers and financial management services agencies (FMSAs) impacted by the Cures Act to select an EVV vendor or choose to use an EVV proprietary system. The Texas Health and Human Services Commission (HHSC) will assign EVV vendors to program providers and FMSAs that miss the deadline.Details are available on the TMHP website at www.tmhp.com. [link]For questions about selecting an EVV vendor or using an EVV proprietary system, contact [email protected].
157 (04/24/20 through 05/15/20) *****Attention All CSHCN Services Program Providers *****To help ensure continuity of care during the COVID-19 (coronavirus) response, the Children with Special Health Care Needs (CSHCN) Services Program has directed TMHP to extend by 90 days existing prior authorizations that require recertification and are set to expire March 1, 2020, through May 31, 2020.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
158 (04/24/20 through 05/15/20) *****Attention All Medicaid Providers*****Effective April 1, 2020, for dates of service on or after February 4, 2020, the reimbursement rates for coronavirus testing procedure codes U0001 and U0002 were implemented.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
159 (04/24/20 through 05/15/20) *****Attention All Medicaid Providers*****Effective for dates of service on or after January 1, 2019, benefit criteria will change for psychological, neurobehavioral, and neuropsychological testing for Texas Medicaid.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
160 (05/01/20 through 05/22/20) *****Attention All Medicaid Providers*****There is an update to the article titled, "First Quarter 2020 HCPCS Updates for Texas Medicaid," which was published on the TMHP website March 24, 2020.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
161 (05/01/20 through 05/22/20) *****Attention All Medicaid Providers*****The Texas National Drug Codes (NDC) to Healthcare Common Procedure Coding System (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 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
162 (04/24/20 through 05/15/20) *****Attention All Medicaid and CSHCN Service Program Providers*****
In response to the COVID-19 public health emergency, hospitals can add alternate physical addresses for temporary off-site facilities.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
163 (05/01/20 through 05/22/20) *****Attention All Medicaid Providers*****The Food and Drug Administration announced a drug shortage for Tacrolimus, part of the Oral Immunosuppressives drug class. In response, the Vendor Drug Program temporarily removed the non-preferred status from the generic formulations of National Drug Codes effective April 17, 2020.Details are available on the TMHP website at www.tmhp.com. [link]
164 (05/01/20 through 05/22/20) *****Attention All CSHCN Services Program Providers*****Effective for dates of service March 15, 2020, through April 30 2020, authorized occupational, physical, and speech therapy for clients of all ages may be delivered as a telehealth service for the Children with Special Healthcare 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 800-568-2413.
165 (05/01/20 through 05/22/20) *****Attention All Medicaid Providers*****The Texas Health and Human Services Commission has been informed of a drug shortage for Methylphenidate ER in the Stimulants drug class.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
166 (05/08/20 through 05/29/20) *****Attention All Medicaid Providers*****TMHP has updated the Electronic Visit Verification (EVV) Portal. Program providers can see a complete list of the improvements to the EVV Portal, EVV Portal standard reports, and EVV training materials on the TMHP website at www.tmhp.com. [link]For more information, contact [email protected].
167 (05/08/20 through 05/29/20) *****Attention All Medicaid Providers*****Effective for dates of service on or after January 1, 2020, antisense oligonucleotides (eteplirsen and nusinersen) 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 800-925-9126.
168 (05/08/20 through 05/29/20) *****Attention All Medicaid Providers*****The Vendor Drug Program will revise the clinical prior authorization criteria for protein convertase subtilisin/kexin type 9 (PCSK9) inhibitors on July 7, 2020.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
169 (05/01/20 through 05/22/20) *****Attention All Medicaid and CSHCN Services Program Providers*****
The process for recovering small overpayments made to providers has changed, and TMHP will no longer pursue overpayment recoveries of $9.99 or less. Providers can focus on credit resolutions and overpayment reports for claims exceeding $9.99.For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
170 (05/08/20 through 05/29/20) *****Attention All CSHCN Services Program Providers *****Diagnosis code U070 for reporting vaping-related disorder is not a benefit of the Children with Special Health Care Needs (CSHCN) Services Program.For more information, call the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
171 (05/08/20 through 05/29/20) *****Attention All Medicaid Providers *****There is a correction to the article titled, "COVID-19 Guidance: Targeted Case Management Through Remote Delivery," which was posted on the TMHP website on April 1, 2020.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
172 (05/08/20 through 05/29/20) *****Attention All CSHCN Services Program Providers *****Effective April 23, 2020, for dates of service on or after January 1, 2020, reimbursement rates for some 2020 Healthcare Common Procedure Coding System procedure codes were implemented for the Children with Special Health Care Needs (CSHCN) Services Program.For more information, call the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
173 (05/01/20 through 05/22/20) *****Attention All Medicaid Providers*****As part of its continued response to COVID-19 (coronavirus), HHSC will provide Medicaid reimbursement for previously identified telemedicine and telehealth services for March 15, 2020, to May 31, 202 dates of service. 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.
174 (05/08/20 through 05/29/20) *****Attention All Providers*****There is an additional update to the article titled, "Update: TMHP to Use Grouper Version 37.1 for Dates of Discharge on or after April 1, 2020," which was published on the TMHP website on April 3, 2020.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
175 (05/08/20 through 05/29/20) *****Attention All Medicaid Providers*****Providers should bill procedure code T1027 for telephone (audio-only) Early Childhood Intervention specialized skills training for dates of services from March 15, 2020, through May 31, 2020.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 (05/08/20 through 05/29/20) *****Attention All Medicaid Providers*****Providers should bill procedure code S9470 for telephone (audio-only) nutritional counseling for dates of services from March 15, 2020, through May 31, 2020. Details are available on the TMHP website at www.tmhp.com. [link]
For more information, call the TMHP Contact Center at 800-925-9126.
177 (05/01/20 through 05/22/20) *****Attention All Medicaid, CSHCN Services Program, FPP, and HTW Providers*****
In response to the current COVID-19 public health emergency, the Office of the Governor granted a waiver to extend Texas Board of Nursing licensure renewal requirements.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
178 (05/08/20 through 05/29/20) *****Attention All Medicaid Providers*****Effective June 1, 2020, information on the process for using Texas Medicaid's Home Health Durable Medical Equipment and Supplies Exceptional Circumstances provision for Medicaid clients 21 years of age and older will become available. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
179 (05/08/20 through 05/29/20) *****Attention All Medicaid Providers*****Beginning April 30, 2020, for dates of service on or after July 1, 2019, diagnosis code G360 will be added as a payable diagnosis for Eculizumab (procedure code J1300).Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
180 (05/08/20 through 05/29/20) *****Attention All CSHCN Services Program Providers *****As part of its continued response to COVID-19 (coronavirus), the Children with Special Health Care Needs (CSHCN) Services Program will provide reimbursement for previously identified telemedicine and telehealth services through May 31, 2020, dates of service.Details are available on the TMHP website at www.tmhp.com. [link]
181 For more information, call the TMHP-CSHCN Services Program Contact Center at 800-568-2413.(05/08/20 through 05/29/20) *****Attention All HTW and FPP Providers ****
As part of its continued response to COVID-19 (coronavirus), Healthy Texas Women and the Family Planning Program will provide reimbursement for previously identified telemedicine and telehealth services through May 31, 2020, dates of service.For more information, call the TMHP Contact Center at 800-925-9126.
182 (05/15/20 through 06/05/20) *****Attention All Medicaid Providers *****When submitting cost reports to TMHP, rural health clinic and federally qualified health center providers should include the Notice of Program Reimbursement (NPR) letter with their submission of the NPR cost report. If the NPR cost report is not available, submit the unaudited cost reports.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
183 (05/15/20 through 06/05/20)*****Attention All Medicaid Providers*****In June, HHSC and TMHP will hold live EVV policy and EVV Portal training webinars for program providers currently required to use EVV.Details, including registration information are available on www.tmhp.com. [link]For more information, contact [email protected].
184 (05/15/20 through 06/05/20) *****Attention All SHARS Providers *****In response to COVID-19 and associated school closures, TMHP is sending the Certification of Funds letter through email to School Health and Related Services providers.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
185 (05/15/20 through 06/05/20) *****Attention All Medicaid Providers*****Effective for dates of service on or after June 1, 2020, benralizumab, mepolizumab, and omalizumab may be provided in the home setting for Texas Medicaid.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
186 (05/15/20 through 06/05/20) *****Attention All Medicaid Providers*****The agenda for the Texas Drug Utilization Review Board meeting on Friday, May 22, 2020, is available. Registration is required to attend. All attendees must complete and submit the Virtual Attendance Registration (HHS Form 1311) by Wednesday, May 20, 2020.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
187 (05/15/20 through 06/05/20) *****Attention All Medicaid Providers*****Effective May 6, 2020 and until further notice, TMHP will not accept additional EVV Proprietary System Request Forms. A new process to manage the large number of applications will be announced this fall or sooner.Details are available on the TMHP website at www.tmhp.com. [link]For more information, contact [email protected]
188 (05/15/20 through 06/05/20) *****Attention All Medicaid and CSHCN Services Program Providers *****
The Ambulance Basics computer-based training has been updated and is now available on the TMHP Learning Management System website.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
189 (05/15/20 through 06/05/20) *****Attention All Medicaid Providers*****To help ensure continuity of care during the COVID-19 (coronavirus) response, the signature requirement waiver for the Durable Medical Equipment Certification and Receipt Form is extended through May 31, 2020.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
190 (05/22/20 through 06/12/20) *****Attention All CSHCN Services Program Providers*****On July 1, 2020, TMHP will implement the second quarter 2020 Healthcare Common Procedure Coding System additions, revisions, and discontinuations, which will be effective for dates of service on or after July 1, 2020. 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 800-568-2413.
191 (05/22/20 through 06/12/20) *****Attention All CSHCN Services Program Providers*****Effective for dates of service on or after July 1, 2020, home visits for respiratory therapy care procedure code 99503 will be limited to 30 per calendar year, by any provider, for the Children with Special Health Care Needs (CSHCN) Services Program.For more information, call the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
192 (05/22/20 through 06/12/20) *****Attention All CSHCN Services Program Providers*****Effective for dates of service on or after June 1 2020, 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.
193 (05/15/20 through 06/12/20)*****Attention All Medicaid and CSHCN Services Program Providers *****
Effective June 26, 2020, a field for medical record number will be added to the financial transactions section of the Remittance and Status Report.For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
194 (05/15/20 through 06/12/20) *****Attention All Medicaid Providers*****Effective for dates of service on or after July 1, 2020, reimbursement criteria will be updated for brachytherapy and therapeutic radiopharmaceuticals for Texas Medicaid.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
195 (05/22/20 through 06/12/20) *****Attention All Medicaid Providers*****On July 1, 2020, TMHP will implement the second quarter 2020 Healthcare Common Procedure Coding System (HCPCS) additions, revisions, and discontinuations, which will be effective for dates of service on or after July 1, 2020. Discontinued procedure codes will no longer be considered as 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 changes in benefits.For clinician administered drug procedure codes included in a quarterly HCPCS update and approved to be added as Medicaid benefits by the Health and Human Services Commission, the rate may be effective as of the Centers for Medicare & Medicaid Services effective date.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
196 (05/22/20 through 06/12/20) *****Attention All Medicaid Providers*****Reminder: TMHP terminates Texas Provider Identifiers (TPIs) that exceed 24 months with no claims activity.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
197 (05/22/20 through 06/12/20) *****Attention All Medicaid Providers*****The quarterly update to the Pharmacy Clinical Prior Authorization Assistance Chart is now available.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
198 05/15/20 through 06/12/20) *****Attention All Medicaid Providers *****On June 1, 2020, hospitals will receive access to their state fiscal year 2019 Potentially Preventable Readmissions and Potentially Preventable Complications hospital-level PDF reports and underlying Excel™ data files.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
199 (05/15/20 through 06/12/20) *****Attention CSHCN Services Program Providers*****To help ensure continuity of care during the COVID-19 (coronavirus) response, the signature requirement waiver for the CSHCN Services Program Documentation of Receipt Form is extended through May 31, 2020.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
200 (05/15/20 through 06/12/20) *****Attention Texas Health Steps Providers*****Effective May 7, 2020, through May 31, 2020, new Texas Health Steps Checkups Guidance.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
201 (05/22/20 through 06/12/20) *****Attention All Medicaid and CSHCN Services Program Providers *****
On June 26, 2020, TMHP will conduct a live webinar designed to offer a high-level introduction to Prior Authorization.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
202 (05/22/20 through 06/12/20) *****Attention All Medicaid and CSHCN Services Program Providers *****
On June 19, 2020, TMHP will conduct a live webinar designed to offer an introduction to the Prior Authorization on the Portal tool. The webinar will include information on how to access and navigate the tool 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 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
203 (05/22/20 through 06/1/20) *****Attention All Medicaid Providers*****There is a correction to the article titled, "Home Health Durable Medical Equipment (DME) and Supplies Exceptional Circumstances Provision for Medicaid Clients 21 Years of Age and Older," which was published on the TMHP website on April 29, 2020. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
204 (05/29/20 through 06/19/20) *****Attention Medicaid and CSHCN Services Program Providers*****
On June 24, 2020, Texas Medicaid & Healthcare Partnership (TMHP) will conduct a live webinar designed to offer an introduction to Medicaid. 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 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
205 (05/29/20 through 06/19/20) *****Attention All Medicaid Providers *****The Texas Health Steps computer-based training and electronic document resources have been updated and they are now available on the TMHP Learning Management System website.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
206 (05/29/20 through 06/19/20) *****Attention All Medicaid Providers *****The Texas Health Steps Program Overview video is available for viewing.
This short video introduces Texas Health Steps and its purpose; how the program works with clients; and how the Health and Human Services Commission and TMHP work together to administer the program.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
207 (05/22/20 through 05/29/20) *****Attention All Providers*****Monday, May 25, 2020, is Memorial Day, which is a bank holiday. As a result, electronic funds transfer (EFT) payments may be delayed by one business day. Providers that receive EFT payments can expect funds by Monday, June 1, 2020.For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
208 (05/22/20 through 05/29/20) *****Attention All Medicaid Providers*****Effective May 28, 2020, for dates of service on or after April 1, 2020, the reimbursement rate for procedure code J9118 (Asparlas) will be updated. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
209 (05/29/20 through 06/19/20) *****Attention All Medicaid Providers*****Effective immediately, hospitals can have claims designated as administered by Mobile Stroke Units for administration of tissue plasminogen activator.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
210 (06/05/20 through 06/26/20) *****Attention All CSHCN Providers*****Effective for dates of service on or after June 1, 2020, Ravulizumab-cwvz (Ultomiris) procedure code J1303 will be a benefit of the Children with Special Health Care Needs (CSHCN) Services Program for clients who are 18 years of age and older.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
211 (06/05/20 through 06/26/20) *****Attention All Medicaid Providers*****Effective for dates of service on or after June 1, 2020, diagnosis codes D588, D593, D594, D595 and D598 will be added as payable diagnoses for Ravulizumab-cwvz (Ultomiris) (procedure code J1303). Additionally, procedure code J1303 may be reimbursed in the office setting.For more information, call the TMHP Contact Center at 800-925-9126.
212 (05/22/20 through 06/12/20) *****Attention All Medicaid Providers*****From July 1, 2020, through November 30, 2020, an Electronic Visit Verification (EVV) practice period will allow program providers and financial management services agencies impacted by the 21st Century Cures Act to practice using the EVV system, EVV Portal, and EVV claims matching. Consumer directed services
employers can practice using the EVV system. EVV claims will not be denied for a mismatch during the practice period.Details are available on the TMHP website at www.tmhp.com. [link]For more information, contact [email protected].
213 (05/22/20 through 06/12/20) *****Attention All Medicaid Providers*****From July 1, 2020, through November 30, 2020, an Electronic Visit Verification (EVV) practice period will allow program providers and financial management services agencies impacted by the 21st Century Cures Act to practice using the EVV system, EVV Portal, and EVV claims matching. Consumer directed services employers can practice using the EVV system. EVV claims will not be denied for a mismatch during the practice period.Details are available on the TMHP website at www.tmhp.com. [link]For more information, contact [email protected].
214 (06/05/20 through 06/26/20) *****Attention Texas Health Steps Providers*****There is an update to the article titled, "Texas Health Steps Checkups Guidance Effective May 7, 2020 through May 31, 2020," which was posted on the TMHP website on May 12, 2020.The update is that the guidance has been extended to be effective from May 7, 2020 through June 30, 2020.For more information, call the TMHP Contact Center at 800-925-9126.
215 (05/29/2020 through 06/19/2020) *****Attention All Medicaid and CSHCN Service Program Providers*****
There is an update to the article titled, "Provider Enrollment Revalidation Due Dates Extended in Response to COVID-19 Emergency," which was published on the TMHP website on April 1, 2020. Details are available at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
216 (05/29/20 through 06/19/20) *****Attention All CHIP Providers*****There is an update to the article titled "CHIP Co-Payments Waived through April 30, 2020," which was published on the TMHP website on April 2, 2020.Details are available at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
217 (06/05/20 through 06/26/20) *****Attention All CSHCN Services Program Providers *****There is an update to the article titled, "Prior Authorization Requests Extended Due to COVID-19 Public Health Emergency," which was posted on the TMHP website on April 16, 2020.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
218 (06/05/20 through 06/26/20) *****Attention All HTW and FPP Providers *****There is an update to the article titled, "Date-of-Service Extension for Telemedicine (Physician-Delivered) and Telehealth (Non-Physician-Delivered) Services," which was posted on the TMHP website on April 30, 2020.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
219 (06/05/20 through 06/26/20) *****Attention All CSHCN Services Program Providers *****There is an update to the article titled, "Date-of-Service Extension for Telemedicine (Physician-Delivered) and Telehealth (Non-Physician-Delivered) Services," which was posted on the TMHP website on April 30, 2020.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
220 (06/05/20 through 06/26/20) *****Attention All Medicaid Providers*****As part of its continued response to COVID-19 (coronavirus), HHSC has extended multiple Medicaid COVID-19 flexibilities through June 30, 2020. Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
221 (06/05/20 through 06/26/20) *****Attention All CSHCN Services Program Providers *****There is an update to the article titled, "Date-of-Service Extension for Telemedicine (Physician-Delivered) and Telehealth (Non-Physician-Delivered) Services," which was posted on the TMHP website on April 30, 2020.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
222 (06/05/20 through 06/26/20) *****Attention All CSHCN Services Program Providers*****There is an update to the article titled, "Waiver Extension for the CSHCN Services Program Documentation of Receipt Form" which was posted on the TMHP website on May 11, 2020.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
223 (06/05/20 through 06/26/20) *****Attention All CSHCN Providers*****Effective for dates of service on or after July 1, 2020, benralizumab, mepolizumab, and omalizumab may be provided in the home setting 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 800-568-2413.
224 (06/12/20 through 07/03/20) *****Attention All CSHCN Services Program Providers*****Effective for dates of service on or after August 1 2020, 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.
225 (06/12/20 through 07/03/20) *****Attention All Medicaid Providers*****Beginning July 1, 2020, all instances of the term ImmTrac will be changed to ImmTrac2 throughout the Texas Medicaid Provider Procedures Manual to align with the name listed on the Texas Immunization Registry. For more information, call the TMHP Contact Center at 800-925-9126.
226 (06/12/20 through 07/03/20) *****Attention All Medicaid Providers*****Effective for dates of service on or after July 1, 2020, prior authorization will be required for crizanlizumab-tmca (Adakveo) (procedure code C9053) for Texas Medicaid.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
227 (06/05/2020 through 06/26/20) *****Attention All Medicaid and CSHCN Services Program Providers*****
There is a correction to the article titled "New Process for Recovering Overpayments," that was published on the TMHP website on May 1, 2020.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
228 (06/05/20 through 05/26/20) *****Attention All Medicaid Providers*****Effective for dates of service on or after July 1, 2020, Esketamine (Spravato) may be distributed through specialty pharmacy providers enrolled in the Spravato Risk and Evaluation Mitigation Strategy (REMS) program to provide services to clients who are 18 years of age or older.For more information, call the TMHP Contact Center at 800-925-9126.
229 (06/12/20 through 07/03/20) *****Attention All Medicaid Providers*****Beginning June 1, 2020, TMHP will update the Texas Medicaid Provider Procedures Manual, Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook, subsection 2.2.16.28, "Feeder Seats, Floor Sitters, Corner Chairs, and Travel Chairs," to align with 42 C.F.R. § 440.70 (b)(3)(v), prohibiting states from having absolute exclusions of coverage on medical equipment, supplies, or appliances.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
230 (06/12/20 through 07/03/20) *****Attention All Medicaid Providers*****On May 27, 2020, the Vendor Drug Program temporarily revised the preferred drug list to address reported possible drug shortages of products in the Platelet Aggregation Inhibitors drug class.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
231 (06/05/20 through 06/26/20) *****Attention Texas Health Steps Providers*****Texas Health and Human Services has published a frequently asked questions resource document for Texas Health Steps telemedicine providers.
232 (06/12/20 through 07/03/20) *****Attention All Medicaid Providers*****Additional procedure codes for coronavirus testing are 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 800-925-9126.
233 (06/12/20 through 07/03/20) *****Attention All Medicaid and CSHCN Services Program Providers*****
There is an update to the article titled, "Coronavirus Testing Procedure Codes to Become a Benefit," which was published on the TMHP website March 16, 2020.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
234 (06/12/20 through 07/03/20) *****Attention All Medicaid Providers*****Additional information is available for coronavirus testing procedure codes that became a benefit of Texas Medicaid effective for dates of services on or after February 4, 2020.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
235 (06/12/20 through 07/03/20) *****Attention All Medicaid Providers*****Effective for dates of service on or after April 1, 2020, calaspargase pegol-mknl (procedure code J9118) is a benefit of Texas Medicaid for clients who are birth through 21 years of age.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
236 (06/12/20 through 07/03/20) *****Attention All Medicaid Providers*****Effective for dates of service on or after August 1, 2020, circumcisions for newborns (procedure codes 54150 and 54160) will be payable to additional provider types.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
237 (06/19/20 through 07/10/20) ***** Attention All Medicaid and CSHCN Services Program Providers *****
TMHP is providing clarification and direction on prior authorization requirements for submitting requests for total caloric intake prescribed by a physician and directions for calculating the total caloric intake for providers that supply nutritional products, supplies, and equipment through the Medicaid Comprehensive Care Program, Medicaid Home Health, 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 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
238 (06/19/20 through 07/10/20) *****Attention All Medicaid Providers*****Effective for dates of service on or after July 1, 2020, prior authorization will be required for brexanolone (Zulresso) (procedure code C9055) for Texas Medicaid.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
239 (06/12/20 through 07/04/20) *****Attention All Medicaid Providers*****Reminder: Providers must complete their revalidation enrollment before the end of their enrollment period. Providers can revalidate their enrollment up to 90 days before their deadlines through Provider Enrollment on the Portal (PEP), available through the TMHP website. Providers who are unable to revalidate through PEP must download and submit the appropriate paper enrollment application.Providers who do not complete the revalidation process by their deadlines will be disenrolled from all Texas state health-care programs; claims and prior authorization requests will be denied.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
240 (06/12/20 through 07/03/20) *****Attention All Medicaid and CSHCN Services Program Providers *****
Electronic funds transfer (EFT) payments could be delayed by one business day due to a payment processing issue that has been resolved at 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 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
241 (06/26/20 through 07/17/20) *****Attention All Medicaid Providers*****The Texas Drug Utilization Review Board met May 22, 2020, to make recommendations for Medicaid clinical prior authorizations and the preferred drug list. A summary of this meeting is now available from 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 800-925-9126.
242 (06/26/20 through 07/17/20) *****Attention All HTW and Family Planning Program Providers*****
Additional procedure codes for coronavirus testing are a benefit of the Healthy Texas Women (HTW) program and the state-funded Family Planning Program.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
243 (06/26/20 through 07/17/20) *****Attention All HTW and Family Planning Program Providers*****
There is an update to the article titled, "Coronavirus (COVID-19) Testing Procedure Codes to Become a Benefit for HTW and Family Planning Programs," which was published on the TMHP website March 23, 2020.Details are available on the TMHP website at www.tmhp.com. [link]
244 (06/26/20 through 07/17/20) *****Attention All Medicaid Providers*****This is a clarification to an article titled "Reimbursement Criteria Updated for Brachytherapy and Therapeutic Radiopharmaceuticals Effective July 1, 2020," which was published on the TMHP website on May 15, 2020.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
245 (06/26/20 through 07/17/20) *****Attention All Medicaid Providers*****Beginning July 1, 2020, providers may bill and receive reimbursement for the unused portion of weight-based or variable dosing clinician-administered drugs manufactured only in single-dose vials. Providers must also include modifier JW on their claims for consideration of reimbursement.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
246 (06/26/20 through 07/17/20) *****Attention All Medicaid Providers*****The Texas Drug Utilization Review Board will meet online using Microsoft Teams on July 24, 2020.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
247 (06/26/20 through 07/17/20) *****Attention All Medicaid Providers*****Effective for dates of service on or after July 1, 2020, TMHP will update the Texas Medicaid Provider Procedures Manual, Medical and Nursing Specialists, Physicians and Physicians Assistants Handbook, section 9.2.60.1 "Brachytherapy."Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP Contact Center at 800-925-9126.
248 (06/26/20 through 07/17/20) *****Attention All CSHCN Services Program Providers*****Beginning July 1, 2020, providers may bill and receive reimbursement for the unused portion of weight-based or variable dosing clinician-administered drugs (CADs) manufactured only in single-dose vials. Providers must also include modifier JW on their claims for consideration of reimbursement.Details are available on the TMHP website at www.tmhp.com. [link]For more information, call the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
