Provider Network News

Carelon Behavioral Health Claims Processing Update

Prior Authorization Updates, Effective: May 30, 2024

Vaccine Services Procedure Code 90623 is Now Available Through TVFC Effective April 1, 2024

Chikungunya Virus Vaccine Is Now a Benefit of Texas Medicaid

Billing Electronic Visit Verification (EVV) Services as Secondary Insurance Claim

PCHP Provider Claim Appeal process effective May 1, 2024

RSV Vaccine Procedure Code 90678 is Now a Benefit for Pregnant Individuals Effective October 1, 2023

PCHP Policy Update to Claim Rejections: Enrollment Mismatch to TMHP Enrollment Broker

FQHC Wrap Payment Process 

PCHP 2024 Prior Authorization Updates – Effective 4/1/2024

Change Healthcare: System Outage Impacting PCHP Operations

Updates to Vaccine Administration Procedure Code M201

RSV Monoclonal Antibody Nirsevimab is a Benefit of Texas Medicaid and CHIP

Health Benefit Plan Coverage of Prescription Contraceptive Drugs Finalized

Coverage of Commercialized COVID-19 Vaccines 

COVID-19 Vaccine Procedure Code 91304 is Now a Benefit of Medicaid and CHIP

Telemedicine and Telehealth Benefit Updates for Rural Health Clinics and Federally Qualified Health

Prior Authorization Criteria Addition for Qalsody begins Oct 1, 2023

Vaccine Services Benefits to Change for Texas Medicaid

TX Medicaid Flu Vaccine Coverage 2023-2024 Season

Age Range Expansion for Pneumococcal 20-Valent Conjugate Vaccine

HHSC Does not cover vaccines or drugs that do not have FDA Approval

Paper Claims Submission

Carelon Behavioral Health To Coordinate with Other Providers

PCHP Partnership with Claris Health 

Effective July 1, 2023: Verisys Facility Credentialing App Submission

COVID-19 Vaccine Administration Procedure Codes

Inpatient Prior Authorization Number

Provider Portal Newborn Notification Form

COVID-19 Vaccine Administration Procedure Code 0174A Is Now a Benefit of Medicaid and CHIP**Action Required and Informational 

Inactive NPI in NPPES to Trigger Disenrollment Action

Infection Control Supplies Procedure Code S8301 No Longer a Benefit Effective May 12, 2023

COVID-19 Vaccine Counseling Procedure Code G3015

Co-Pays for some CHIP service will resume starting May 12, 2023

COVID-19 Vaccine Administration Procedure Codes 0124A, & 0134A

COVID-19 Vaccine Administration Procedure Codes 0164A

Diabetic Equipment and Supplies Benefits to Change

Update to Procedure Code Q0222

Update to Age Restrictions for Vaccine Procedure Codes 90671 and 90756

COVID-19 Vaccine Administration Procedure Code 0041A and 0042A

CoCM Benefit: Provider Attestation Form Effective 1/1/2023

Health Advisory: Influenza Activity in Dallas County 11/28/2022

COVID-19 Vaccine Administration Procedure Code 0044A benefit *new 10/19/2022*

EVV Cures Act Home Health Care Services Implementation Confirmed for Jan. 1, 2024 

Grant PCHP Access to Your EHR/EMR for Medical Record Review, HEDIS, and ECDS Purposes

Case Management for Children & Pregnant Women (CPW) effective September 1, 2022

The Collaborative Care Model New Medicaid Benefit Effective June 1, 2022

Updates to Age Restriction for Procedure Code 90619

COVID-19 Vaccine Administration Procedure Codes

Federal Entitlement to ECI

Dental Therapy Under General Anesthesia

Prior Authorizations Reprocessing

Removal of Coordination of Benefits (COB)

ABA Medicaid Benefit effective February 2022

ECI And CCP Requirements

CHIP Renewal

Guidance on Asthma Education Coverage in Medicaid and CHIP

New Payment Methods Starting April 2021

PCHP Covid-19 CHIP Provider Co-pay Attestation Form 093020

90 Extension of Prior Authorizations - 07312020

PCHP Telemedicine and Telehealth_revised 07012020

813_PCHPTaxonomy_Provider 05-13-2019

ImmTrac2 - Immunization Registry - 4-15-20 mnd v2

SLP Provider Notification March 2020

PCHP Neonatal LOC Validation on Facility Claims Notice_TX 02-16-2020

Notice to Physicians and Providers Parkland 01-27-2020

Inform Providers 2012 American Dental Association Claim Form can not to be used after 12-31-2019

Lab Web Portal is Not Available by Nov 10-2019

PCHP _ Influenza Vaccine September 2019

Updated Version of the American Dental Association Claim Form Now Available 08-30-2019

F00090_Sterilization_Consent_Form April 2019 English

F00090_Sterilization_Consent_Form April 2019 Spanish

F00090_Sterilization_Consent_Form_Instructions April 2019

Reminder Changes to Sterilization Consent Form Instruc-Denial Letter Eff 04-26-2019

Inform Providers About the Time Limit for Use of the 2012 American Dental Association Claim Form 2019

Providers Required to Use 2018 and 2019 American Dental Association Claim Forms by Jan 2019

Synagis Network 2018-2019

PCHP Acceptable and Non Acceptable November 2018

PCHP Therapy Wait List 11-05-2018

082818-Updated Provider Information Change Form Now Available 08-28-2018

Wound Care Equipment and Supply Benefits Change 07-01-2018

HEIDIS Results CHIP 2017 released 06-27-2018

HEIDIS Results STAR 2017 released 06-27-2018

Clarification for Providers Regarding MCO Therapy Guidance 06-22-2018

PCHP Delivery Claim Billing effective Feb 1 2018 _ Update 5-17-2018

CHIP Member Eligibility Now Available via EDI HIPAA X12 270 and 271 Transaction 04-09-2018

LARC Notice 01-08-2018

Access to Care Guidelines