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06/16/2026
PCHP has completed an annual review of all services requiring prior authorization. This provider network news alert is notification only of updates and does not determine if the benefit is covered by PCHP.
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06/10/2026
Last updated on 5/29/2026. Effective for dates of service on or after July 1, 2026, vestronidase alfa-vjbk (Mepsevii) (procedure code J3397) is a benefit of Texas Medicaid when provided in the home setting. Additionally, on July 1, 2026, the Texas Medicaid & Healthcare Partnership (TMHP) will move the benefit information about vestronidase alfa-vjbk (Mepsevii) in the Texas Medicaid Provider Procedures Manual (TMPPM), Outpatient Drug Services Handbook from subsection 6.83, “Mepsevii (Vestronidase alfa...
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06/09/2026
Last updated on 5/29/2026 Effective May 14, 2026, for dates of service on or after October 1, 2024, the Texas Medicaid & Healthcare Partnership (TMHP) has deleted invalid diagnosis code M0259 and updated it to valid diagnosis code M0529 on injection tocilizumab-aazg (Tyenne) (procedure code Q5135). The diagnosis code M0259 was incorrectly listed. The correct diagnosis code is M0529.
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06/03/2026
Texas Medicaid now covers adult vaccines under pharmacy benefits, for eligible members 19 years and older
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05/21/2026
Parkland Community Health Plan (PCHP) would like to notify providers of an important update from the Texas Health and Human Services Commission (HHSC). On July 1, 2026, the Texas Medicaid & Healthcare Partnership (TMHP) will update the Texas Medicaid Provider Procedures Manual (TMPPM) to revise language regarding record retention requirements for telemedicine medical services, teledentistry dental services, and telehealth services in accordance with House Bill 1700, 89th Legislature, Regular Session,...
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05/21/2026
On June 1, 2026, the Texas Medicaid & Healthcare Partnership (TMHP) will update section 9.2.47, “Newborn Services,” in the Texas Medicaid Provider Procedures Manual (TMPPM), Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook to remove the reference to procedure code 99360, which is not a benefit of Texas Medicaid. For more information, call the TMHP Contact Center at 800-925-9126.
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05/21/2026
Parkland Community Health Plan (PCHP) would like to inform our network providers of an upcoming change to the Texas Medicaid & Healthcare Partnership (TMHP) login process. New Login Process Effective June 12, 2026 Beginning June 12, 2026, TMHP will transition to the TMHP IAMOnline platform as the new, secure entry point for accessing applications on tmhp.com. This platform provides a centralized, single sign-on experience for accessing TMHP systems. Important: This new login process applies only to T...
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05/19/2026
Why Follow-Up Care Matters Timely follow-up after emergency department (ED) visits or hospitalization for mental health and substance use conditions is critical to improving patient outcomes, reducing readmissions and future hospitalization, and ensuring continuity of care. • Reduces repeat ED visits • Improves care engagement and recovery • Supports medication adherence and care coordination Measure Overview Two key HEDIS measures assess follow-up care after ED visits: • FUH: Follow-Up After Hospitaliz...
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05/18/2026
Provider Network News May 14, 2026 Important Notice: CLIA Implementation Delayed Parkland Community Health Plan (PCHP) would like to notify providers of an important update from the Texas Health and Human Services Commission (HHSC) regarding Clinical Laboratory Improvement Amendments (CLIA) requirements. Key Details • The previously scheduled June 1, 2026 implementation of CLIA-related claim denials based on PEMS data has been delayed until further notice. • HHSC anticipates a delay of at least three mon...
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05/05/2026
Why Consistent Monitoring Matters. Consistent diabetes monitoring prevents avoidable complications, reduces ED utilization, and supports value-based quality outcomes. Many HEDIS non-compliance gaps are due to missing documentation rather than lack of care. GSD – Glycemic Status Assessment for Patients with Diabetes. Who: Members age 18–75 with Type 1 or Type 2 diabetes. What Counts: Most recent HbA1c or GMI result during the measurement year (Measurement year January 1–December 31). Targets: HbA1c &...
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04/15/2026
PCHP has completed an adhoc review of all services requiring prior authorization. This communication is for notification purposes only and does not determine if a benefit is covered by PCHP.
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04/14/2026
Parkland Community Health Plan is notifying its in-network (INN) providers of an upcoming change from the Texas Medicaid & Healthcare Partnership (TMHP). TMHP will transition to IAMOnline as the new login platform for accessing applications on the TMHP website.
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04/06/2026
The March 2026 update of the Texas Medicaid Provider Procedures Manual Vol. 2: Physical Therapy, Occupational Therapy, and Speech Therapy Services Handbook (Section 5.3) includes important reminders about testing for developmental delay criteria in children from birth through 20 years of age.
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03/16/2026
This guide provides Parkland Community Health Plan therapy providers with a concise overview of authorization timelines, recertification requirements, and documentation standards to support compliant and timely care delivery.
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03/04/2026
Parkland Community Health Plan (PCHP) is issuing this reminder to ensure all contracted providers remain compliant with Texas Medicaid, including STAR and CHIP program requirements. Providers are prohibited from balance billing Medicaid and CHIP members for any covered services. Note: CHIP members may still be responsible for applicable copayments, coinsurance, and deductibles.
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03/03/2026
Effective June 1, 2026: Claims without appropriate CLIA certification will be denied. Parkland Community Health Plan (PCHP) is reminding providers that all laboratory service providers must comply with the Clinical Laboratory Improvement Amendments (CLIA) regulations. To ensure accurate processing and compliance with Texas Medicaid requirements: • Providers must maintain and submit valid CLIA certifications. • Providers may only bill for laboratory services that fall within the scope of their active CLIA...
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02/26/2026
What is Adalimumab Used For? Adalimumab is a TNF-ɑ inhibitor used across multiple specialties, including: • rheumatology (RA, PsA, AS) • dermatology (plaque psoriasis, HS) • gastroenterology (Crohn’s, UC) • ophthalmology (uveitis) These conditions often require consistent long-term therapy. Biosimilars are clinically equivalent to generic drugs for a biologic. They are: • highly similar to Humira®. • expected to have no clinically meaningful differences in effectiveness, safety, or immunogenicity.
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02/13/2026
On April 1, 2026, the Texas Medicaid & Healthcare Partnership (TMHP) will update the “Prior Authorization for Stereotactic Radiosurgery” section of the Texas Medicaid Provider Procedures Manual (TMPPM), Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook to add pediatric cancers as a covered medical condition for prior authorization.
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02/13/2026
Effective February 12, 2026, the Texas Health and Human Services Commission (HHSC) Vendor Drug Program will remove some ibuprofen National Drug Codes (NDCs) from the Children’s Health Insurance Program (CHIP) formulary.
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02/12/2026
PCHP has completed an adhoc review of all services requiring prior authorization. This communication is for notification purposes only and does not determine if a benefit is covered by PCHP. For specific CPT codes requiring prior authorization by PCHP, please review PCHP’s Prior Authorization List.