Labor Day Holiday Día del Trabajo

Texas Children's Health Plan will be closed on Monday, September 1st, in observance of Labor 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, September 2nd. Wishing you a safe and happy Labor Day!

Texas Children's Health Plan estará cerrado el lunes 1 de septiembre por el Día del Trabajo. Durante nuestra ausencia, puedes comunicarse con nuestra línea telefónica de ayuda fuera del horario habitual al 1-800-686-3831. Reanudaremos nuestro horario regular el martes 2 de septiembre. ¡Te deseamos un feliz y seguro Día del Trabajo!

New Rewards Coming Soon! ¡Se vienen nuevas recompensas!

Our Healthy Rewards Program is getting an update in September! For a sneak peek of all the changes - including new rewards and ways to redeem them - please click here.

¡Nuestro Programa Healthy Rewards tendrá su actualización en septiembre! Para ver un adelanto de todos los cambios, incluyendo nuevas recompensas y formas de canjearlas, haz clic aquí.

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Reimbursement Rate Updates for Certain HCPCS Drug Procedure Codes

Date: July 7, 2025

Attention: All Providers

Effective date: September 20, 2025

Call to action: The purpose of this communication is to inform providers that effective for dates of service on or after April 1, 2025, the Texas Medicaid & Healthcare Partnership (TMHP) will change the reimbursement rates for certain Healthcare Common Procedure Coding System (HCPCS) drug procedure codes that were updated during the first quarter of 2025. These rate updates will be implemented for Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program.

TMHP will reprocess any affected claims that are identified. Providers can appeal the claims if TMHP denies them for additional reasons after reprocessing is completed.

Please note: Prior authorization will be required for the affected HCPCS drug procedure codes as part of this update.

To view the updates, access the following spreadsheets: 

Next steps: Providers should share this communication with their staff. 

If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org. 

For access to all provider alerts:
www.texaschildrenshealthplan.org/provideralerts.