Texas Children's Health Plan will be closed on Monday, September 1st, in observance of Labor Day. In our absence, you can reach our after-hours nurse help line at 1-800-686-3831. We will resume normal business hours on Tuesday, September 2nd. Wishing you a safe and happy Labor Day!
Texas Children's Health Plan estará cerrado el lunes 1 de septiembre por el Día del Trabajo. Durante nuestra ausencia, puedes comunicarse con nuestra línea telefónica de ayuda fuera del horario habitual al 1-800-686-3831. Reanudaremos nuestro horario regular el martes 2 de septiembre. ¡Te deseamos un feliz y seguro Día del Trabajo!
New Rewards Coming Soon!¡Se vienen nuevas recompensas!
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.
COVID-19 Vaccine Administration Code 0004A Now a Medicaid Benefit
Date: October 18, 2021
Attention: Primary Care Providers
Effective Date: Dates of service on or after September 22, 2021Providers 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: Effective for dates of service on or after September 22, 2021, in accordance with the U.S. Food and Drug Administration (FDA) amendment to the Emergency Use Authorization (EUA), COVID-19 vaccine administration code 0004A is now a benefit of Medicaid. Procedure code 0004A, the booster dose of the Pfizer-BioNTech COVID-19 vaccine, should be administered at least six months after completion of the primary series of the Pfizer-BioNTech COVID-19 vaccine.
How this impacts providers: The FDA amendment to the EUA allows for the use of a single booster dose of the Pfizer-BioNTech COVID-19 vaccine, at least six months after completion of the primary series in:
Individuals 65 years of age and older
Long-term care facility residents
Individuals 18 through 64 years of age with underlying medical conditions
Individuals 18 through 64 years of age at increased risk for exposure and transmission due to occupational or institutional setting
Procedure code 0004A is a benefit for Medicaid for the following providers and places of service:
Procedure code M0201 (COVID-19 vaccine administration inside a patient’s home) can be billed in the Home setting with procedure code 0004A, as of September 22, 2021.
Providers may bill MCOs retroactively for COVID-19 vaccine administration code 0004A provided on or after September 22, 2021. MCOs must reprocess affected claims submitted with the procedure code and date of service on or after September 22, 2021. Providers are not required to appeal the claims unless they are denied for additional reasons after the claims reprocessing is complete.
Next steps for providers: Providers should share this communication with their staff.
If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.For access to all provider alerts,log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers
