Rendering Provider Edit Requirements

Date: March 23, 2022 Attention: All Providers Effective Date: June 21, 2022Providers 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. Regarding system configuration updates, TCHP will apply updates and reprocess impacted claims as soon as possible. However, due to volume, please allow up to sixty (60) business days to complete. Providers are not required to appeal the claims unless they are denied for other reasons after the claims reprocessing is complete. Providers should direct questions to their assigned Provider Relations Liaison or send an email inquiry to the Provider Relations Department at providerrelations@texaschildrens.org. Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers of new billing requirements for the rendering provider that will go into effect 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

Exemptions: 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 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.