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Cold and flu season Temporada de influenza y resfriados

ALERT: Stay healthy this cold and flu season! Learn more

ALERTA: ¡Mantente sano durante esta temporada de influenza y resfriados! Más información

New Website! ¡Nuevo sitio web!

ALERT: We have made the Texas Children’s Health Plan website even easier to use! Click here to learn more.

ALERTA: ¡Ahora el sitio web de Texas Children’s Health Plan es aún más sencillo de usar! Haz clic aquí para más información.

Enfamil shortage updates Escasez de Enfamil Reguline

ALERT: Shortage of Enfamil products until October 31, 2024. Learn more.

ALERTA: Escasez de productos de Enfamil hasta el 31 de octubre de 2024. Más información.

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Health Insurance Portability and Accountability Act (HIPAA) Compliant Reasons for Denials and Adjustments

Attention:  All Providers Health Insurance Portability and Accountability Act (HIPAA) Compliant Reasons for Denials and Adjustments   Beginning May 15, 2019, Texas Children’s Health Plan (TCHP) providers will see positive changes to their HIPAA standard 835 electronic remittance and paper explanations of payments (EOPs). TCHP will be providing more robust and HIPAA compliant messages by utilizing national standard claim adjustment reason codes (CARCs) and remittance advice remark codes (RARCs). What are CARCs and RARCs? CARCs and RARCs are industry standard code sets used to explain payment adjustments in remittance advice transactions.
  • CARCs communicate a reason for a payment adjustment that describes why a claim or service line was paid differently than it was billed.
  • RARCs are used to provide additional explanation for an adjustment already described by a CARC or to convey information about remittance processing.
Benefits of CARC and RARC codes CARC and RARC enhancements benefit TCHP providers by:
  • Promoting consistency in reporting adjustment and remittance advice with national standards.
  • Providing additional claims disposition transparency.
  • Simplifying reasons for administrative staff during the payment posting and reconciliation processes.
Standardized descriptions for HIPAA compliant CARCs and RARCs can be accessed on the Washington Publishing Company’s website at http://www.wpc-edi.com/codes. TCHP Provider Portal 835 Remittance Advice Report Future Update TCHP Provider Portal, X12-835 Remittance Advise Reports will not display all CARC and RARC reasons on May 15, 2019. The remit messages that currently display on this report will continue until a future date has been determined. TCHP will send an additional communication when this enhancement is set to occur. If you have any questions regarding these codes, please contact our Texas Children’s Health Plan Customer Service department at 832-828-1004 or toll-free at 1-877-213-5508. Provider Network ManagementTexas Children's Health Plan