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: The purpose of this communication is to inform providers and their designated clearinghouses of the new custom edits scheduled to go live on November 2025. These edits will reject claims before they enter our claims adjudication system if the submitted data does not meet required standards.
How rejections will be communicated:
When a claim is rejected, you will receive a 277CA (Claim Acknowledgment) transaction with the rejection reason.
The rejection reason will be displayed in Loop 2220D, STC segment, element STC12.
The 277CA will be sent to the same entity that currently receives payer rejections today (e.g., your clearinghouse or billing service).
New edits that will cause rejections:
Billing Provider Tax ID
Billing Provider tax ID must be submitted in the correct format per 5010 requirements.
Autism Services
Autism services must be submitted with valid data elements including, CPT code, client age, rendering provider taxonomy, diagnosis code and billing provider entity type.
Zip Code
Zip Codes must be submitted in the correct format per 5010 requirements. (5-digit or 9-digit)
Invalid Frequency Code
UB04 and CMS claims must be submitted with the correct frequency code.
Patient Loop
Patient Loop 2000C is invalid and should not be submitted.
Service Facility Address
Service Facility address must be submitted with a physical address. (no PO Boxes)
Next step for Providers: Providers should share this communication with their billing staff and clearinghouse.
