Our Healthy Rewards Program is getting an update in September! For a sneak peek of all the changes - including new rewards and ways to redeem them - please click here.
¡Nuestro Programa Healthy Rewards tendrá su actualización en septiembre! Para ver un adelanto de todos los cambios, incluyendo nuevas recompensas y formas de canjearlas, haz clic aquí.
Prior Authorization Guideline updates for Private Duty Nursing (PDN) and therapy specialty services
Attention: All Providers
Effective Date: July 18, 2020 for PDN and August 11, 2020 for therapy Services
Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event. TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event.
Call to action: TCHP would like to inform you of recent updates to the prior authorization requirements and the effective dates. Updates include the following:
Private Duty Nursing, effective July 18, 2020
Nursing notes are no longer required but are recommended for medical necessity determination.
The request can now be submitted within 60 days of end date of the current authorization.
The member needs a treating provider visit at least every year (or every 365 days). This requirement is waived during the COVID disaster declaration period.
Physical therapy, occupational therapy speech therapy, effective August 11, 2020
Providers may submit a prior authorization or service authorization request for services at least 60 Days prior to the expiration of the current authorization period.
For change of coverage due to MCO transfers and Continuity of Care, the authorization request will not be considered retrospective if submitted within the same month of the enrollment date.
