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Memorial Day Holiday Horario de Días Festivos

Texas Children's Health Plan will be closed on Monday, May 26th, in observance of Memorial 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, May 27th. Wishing you a safe and happy Memorial Day weekend!

Texas Children’s Health Plan estará cerrado el lunes 26 de mayo por el feriado. Durante nuestra ausencia, puede comunicarse con nuestra línea telefónica de ayuda 24/7 fuera del horario de atención al 1-800-686-3831. Reanudaremos nuestro horario habitual el martes 27 de mayo. ¡Le deseamos un fin de semana festivo seguro y feliz!

Cold and flu season Temporada 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

A suitable timeline for prenatal and postpartum care

Timely prenatal and postpartum care is an important component of successful health outcomes for women and their babies, as well as a measure of quality care. Prenatal visit The first prenatal visit must be rendered in the first trimester or during the first 42 days of enrollment into the health plan to meet the standards set forth by Healthcare Effectiveness Data and Information Set (HEDIS). Postpartum visit In order for the visit to qualify as a postpartum visit, it must include documentation in the chart showing the date of the visit and ONE of these 3 services:
  • Pelvic exam OR;
  • Weight evaluation, blood pressure, breast, and abdomen exam (if there is no breast examination, notation of breastfeeding education is acceptable) OR;
  • Notation of postpartum care, including but not limited to the following:
  1. Notation of “postpartum care,” “PP care,” “PP check,” or “6-week check”.
  2. A preprinted “Postpartum Care” form in which information was documented during the visit.
The postpartum visit must be rendered within the specified HEDIS timeline of 21 to 56 days after delivery.
  • Providers need to bill with the CPT code 59430 on the claim form.
  • Only one postpartum visit is required during the 21 to 56 days after delivery (using the 59430 code).
  • Any additional visits that may be needed from Day 1 to Day 56 should be billed with E/M visit codes. This includes visits that occur 1 to 20 days after delivery, which should be billed utilizing E/M codes on the claim form (e.g. C-section incision, episiotomy, blood pressure check, mastitis, etc.).