Date: August 12, 2022
Attention: All Providers
Effective Dates: June 21, 2022 for rendering edit requirements overallSeptember 6, 2022 for new exemptionsProviders shouldmonitor 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: Texas Children’s Health Plan (TCHP) would like to remind providers of new billing requirements for the rendering provider that went into effect on June 21, 2022. This update in accordance with the guidance from the Texas Medicaid Provider Procedures Manual (TMPPM) section 6.1.2, Claims Filing Instructions. In order for claims to process accordingly providers may need to update their billing practices. Our contracted clearinghouse, Change Healthcare (CHC), will reject any claims that do not contain proper Billing Provider Taxonomy Numbers and/or Billing Providers NPI’s, or rendering provider taxonomy.
Resource: TMPPM Section 6.1.2, Claims Filing Instructions
How this impacts providers: Here is a summary of the required fields for Professional 837P (CMS/1500) Claims:
Loop /Segment
Description
2000A PRV (billing taxonomy required)*
2300 CLM05-01 (header, place of service code)
2400 SV105 (service detail, place of service code)
§ This applies to all organizational types Group and person.
§ If group, then rendering provider name, NPI, and Taxonomy are required and a valid NPI and valid Taxonomy.
§ Taxonomy and NPI used should be those attested with at Texas Medicaid
§ There are no attestation checks at CHC; this is done at TCHP for billing provider and rendering provider.
§ CHC will check the following:
§ Each detail service line. If “ALL” lines do not meet exemption Place of Service (POS) list, the edit for rendering provider/taxonomy will appear and
§ CHC will also check the header and service detail line POS values.
§ TCHP’s contracted clearinghouse, CHC, will reject any claims that do not contain proper Rendering Provider Taxonomy Numbers and/or Rendering Providers NPI’s
2310B PRV (Rendering Provider Taxonomy required if not excluded)
§ Taxonomy and NPI used should be those attested with at Texas Medicaid
*2000A PRV (Billing Taxonomy to Bypass)
332B00000X
332S00000X
261QA0600X
261QD1600X
305R00000X
311ZA0620X
253J00000X
261QM0850X
261QM3000X
261QR0405X
3104A0630X
251B00000X
101YP2500X
146D00000X
171M00000X
333300000X
335E00000X
251S00000X
251C00000X
251E00000X
251G00000X
253Z00000X
261Q00000X
177F00000X
193200000X
174200000X
332U00000X
310400000X
313M00000X
314000000X
372500000X
373H00000X
376K00000X
225X00000X
171W00000X
171WH0202X
171WV0202X
347C00000X
225100000X
251J00000X
374U00000X
3747P1801X
372600000X
376J00000X
385HR2050X
385HR2055X
385HR2060X
385HR2065X
261QH0700X
261QM0801X
305S00000X
Exemptions:
NEW exemption information effective September 6, 2022: Some CPT/HCPCS Codes with G/H/T as follows:
The following Place of Service codes do not require a rendering provider:
10 Telehealth Provided in Patient’s Home
12 Home
25 Birthing Center
31 Skilled Nursing Facility
32 Nursing Facility
33 Custodial Care Facility
34 Hospice
41 Ambulance-Land
42 Ambulance- Air or Water
50 Federally-Qualified Health Center
62 Comprehensive Inpatient Rehabilitation Center
65 End-Stage Renal Disease Treatment Facility
72 Rural Health Clinic
81 Independent Laboratory
Next steps for providers: Providers should share this communication with their billing staff and work with their clearinghouse to ensure updates are made prior to the effective date.
If you have any questions, please contact your Provider Relations Liaison or email the Provider Relations Department at: providerrelations@texaschildrens.org.For access to all provider alerts,log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers
