Flu Season Alert!Alerta de temporada de influenza:
Don’t let germs win this season – protect yourself and your family!
The flu vaccine is your best defense against flu and related complications – PLUS, it is a covered benefit for Texas Children’s Health Plan members! Learn more!
¡No permitas que los gérmenes ganen esta temporada! ¡Protégete a ti y a tu familia!
La vacuna contra la influenza es tu mejor defensa contra la influenza y sus complicaciones. Además, ¡es un beneficio cubierto para los miembros de Texas Children's Health Plan! Aprende más
Call to action: As a reminder, Texas Children’s Health Plan (TCHP) aligns with the Texas Medicaid Provider Procedure Manual (TMPPM) regarding the ICD-10-CM diagnosis-coding requirement on claim submissions.
How this impacts providers: Diagnosis codes guidance as outlined in the TMPPM are as follows:
Diagnosis codes must be to the highest level of specificity available
Diagnosis codes must be appropriate for the age of the client as identified in the ICD-10-CM description of the diagnosis code
Non-specific diagnosis codes have a negative impact on the 278 file that TCHP sends to Health and Human Services Commission.
Next step for Providers: Providers must adhere to the guidelines in this communication on diagnosis- coding as part of the claim submission process. Claims that are denied by TCHP because one or more of the diagnosis codes submitted on the claim are not appropriate for the age of the client, or other reason, may be appealed with the correct diagnosis code or documentation of medical necessity to justify the use of the diagnosis code.
