Texas Children's Health Plan will be closed on Friday, July 4th, in observance of Independence 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 Monday, July 7th. Wishing you a safe and happy Independence Day!
Texas Children's Health Plan estará cerrado el viernes 4 de julio por el Día de la Independencia. Durante este tiempo, puede comunicarse con nuestra línea de ayuda disponible las 24 horas, los 7 días de la semana, al 1-800-686-3831. Reanudaremos nuestro horario habitual el lunes 7 de julio. ¡Le deseamos un feliz y seguro el Día de la Independencia!
Cold and flu seasonTemporada 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
Clinical Prior Authorization Criteria Revisions Implement for Medicaid Fee-for-Service on October 26
Date: October 5, 2022 Attention: All Providers Subject: Effective Date: October 26, 2022Providers 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: Texas Children Health Plan (TCHP) will revise the clinical prior authorization criteria for the Anxiolytics and Sedative/Hypnotics (ASH), Attention Deficit Disorder/Attention-Deficit Hyperactivity Disorder (ADD/ADHD), and Qelbree (also within the ADD/ADHD Medications document) prior authorizations based on recent U.S. Food and Drug Administration (FDA) approved indications.
How this impacts providers: Effective October 26, 2022, the following revisions will be implemented:
Anxiolytics and Sedative/Hypnotics prior authorization criteria
ICD-10 code: F13.90 "Sedative, Hypnotic, or Anxiolytic Use, Unspecified, Uncomplicated" is no longer considered a diagnosis of drug abuse
ADD/ADHD clinical prior authorization criteria
New drugs were added to the clinical prior authorization criteria: Amphetamine extended release (ER) 1.25 mg/mL suspension, Methylphenidate extended release (ER) capsules and Methylphenidate long acting (LA)
Age check for Qelbree has been expanded to 6 years and older
For patients greater than or equal to 18 years prescribed non stimulants agents, a diagnosis of ADD/ADHD is no longer required.