Notices and newsletters

Summer newsletter (PDF)

Spring newsletter (PDF)

Winter newsletter (PDF)

• Global Alignment (PDF)
• Quick reference guide (PDF)
• Rider 32 provider notification (PDF)
• Rider 32 Procedure Code List (PDF)
• Provider Notice: Rider 32 Provider Notification Language (PDF)
• Provider Notice of Cologuard Kits mailed to members (PDF)
• eviCore Delegated Codes Dec 2024 (PDF)
• ENT Code Request for Evaluation of HP FS and PA Requirements (PDF)
• Prior Authorization Criteria for Imetelstat (Rytelo) Effective February 1 2025 (PDF)
• Q1 2025 New Codes (PDF)
• Global alignmnet request to PA No (62367, 62368, 62370 and 93325) (PDF)
• Provider Guidance When ABHTX is Secondary (PDF)
• Patient status 30 with claim frequency 1 4 or 5 will be Denied (PDF)

Fall newsletter (PDF)

Summer newsletter (PDF)

Spring newsletter (PDF)

Winter newsletter (PDF)

Provider Guidance When ABHTX is Secondary (PDF)

CPT II Code Incentive Program (PDF)

KRYSTEXXA 8 MG/ML VIAL J2507 (PDF)

TX-Acorp alignment Governance Committee L5926, 22800, 22804, 22810, J9030 (PDF)

Provider CPT II Letter (PDF)

New codes 2024 (PDF)

In-Lieu-Of Services for Texas (ILOS) – Adult Partial Hospitalization Program and Intensive Outpatient Program (PDF)

Q4 New Codes-Effective 10/01/2024 (PDF)

GCIT Program Reconciliation (PDF)

ProPat Alignment 2024 (PDF)

PPECC Benefit Criteria and PA Updates Effective December 1, 2024

Reminder: Provider Enrollment Revalidation Requirements | TMHP

Enhancing claims intake editing for SNIP Types 1 – 4 through a software change (PDF)

Provider Notification Commercial Payer ID (PDF)

CLIA Certificate Editing Provider Notification (PDF)

Aetna and Quest Analytics Partnership (PDF)

EFT ERA enrollment notification - ECHO vendor change (PDF)

Reinstatement of CHIP Co-pays for COVID-19 Vaccines (PDF)

Gender Affirming Care (PDF)

Prior Authorization Criteria for Adzynma (Apadamtase alfa) and Pombiliti (Cipaglucosidase alfa-atga (PDF)

Genetic Testing- Unit Limitation (PDF)

Bariatric Surgery (PDF)

CHIP Perinate VAS - Dental through Dentaquest (PDF)

Unlisted Codes Guidance for Prior Authorization (PDF)

Clinical SAI Medicaid 2024 Provider Notification Eff 7/1/2024 (PDF)

Genetic Testing Plus Provider Notice (PDF)

Maternal Mental Health (MMH) Guidance Opt Out Notice (PDF)

Mobile Crisis Outreach Team (PDF)

Approved-2024 Acceptable and Not acceptable as an MSRP (PDF)

Coverage of Vyjuvek Begins Jan. 2024; Prior Authorization Effective Feb. 2024 (PDF)

Adstiladrin J9029 (PDF)

ABHTX Durable Medical Equipment Certification and Receipt: Effective May 1, 2024 (PDF)

CHIP Perinatal Post Partum (PDF)

Adsriladrin (PDF)

12-Month Postpartum Eligibility Extension for Medicaid and CHIP  Pregnant Members (PDF)

HB12 FAQs Approved (PDF)

HB12 One Pager approved (PDF)

Aetna Medicaid COB Recovery Process Refund Check Application (PDF)

Implementation of Hormonal Therapy Agents Clinical Prior Authorization (PDF)

Global change recommendations (PDF)

Fall newsletter (PDF)

Summer newsletter (PDF)

Spring newsletter (PDF)

Winter newsletter (PDF)

Notice to physcians and providers (PDF)

Elevidys  J1413 (PDF)

Qalsody  C9157 (PDF)

Roctavian J1412 (PDF)

Wound Care Supplies Requiring PA per TMPPM (PDF)

UNLIS PX DENTOALVEOLAR STRUXS - Facility Fee (PDF)

Nutritional Enteral Products (PDF)

Urgent vs Non-urgent Prior Authorization Requests (PDF)

UMSC Removing Evicore delegation - bringing 93462 and 93352 back to HP (PDF)

Vaccine Services Benefits to Change for Texas Medicaid Effective October 1, 2023 (PDF)

NIPS for CHIP Perinate Non Cov to Cov limit 1 per pregnancy (PDF)

Removal of PA requirement for 95811, 95782, 95783, and 95720 (PDF)

Prior Authorization Criteria for Hemgenix Begins Nov. 1, 2023 (PDF)

Prior Authorization Criteria for Leqembi Begins Nov. 1, 2023 (PDF)

Prior Authorization required for Teplizumab J9381 (PDF)

Prior Authorization not required for Case Management Services G9012 (PDF)

Prior Authorization required for Skysona J3590 (PDF)

Prior Authorization required for Zynteglo J3590 (PDF)

COVID-19 Vaccine Administration Procedure Codes Are Now Benefits of Medicaid and CHIP (PDF)

Cinryze (PDF)

Wound care managment (PDF)

Imaging of retina (PDF)

COVID-19 Vaccine Counseling Procedure Code (PDF)

UMSC - 34 Covid-19 Codes with FDA Approval No Longer Authorized (PDF)

EFT ERA Provider Communication All Plans (PDF)

COVID 19 Vaccine Administration Procedure Codes (PDF)

Inactive NPI in NPPES Trigger Action (PDF)

Medicaid providers-CVS specialty fax copy (PDF)

Prior Authorization Criteria for Histrelin implant (PDF)

Prior Authorization Criteria for Xenpozyme (PDF)

Prior Authorization DME (PDF)

EMR info missing (PDF)

Hepatitis C Treatment Coverage Update Scheduled for Jan. 1, 2023 (PDF)

Preferred Mavyret for Hepatitis C Infection Treatment and Change to Quantity Limit for Hepatitis (PDF)

Provider enrollment revalidation extensions to end 5/11/23 (PDF)

OB Ultrasound policy update (PDF)

Makena FDA Withdrawal (PDF)

MCO Notice Attachment Attestation Form_Update to COVID-19 Accommodations for the Member State Fair Hearing Process (PDF)

Reinstatement of CHIP copays for medical office visits (PDF)

Transplants require PA (PDF)

Provider enrollment revalidation extensions (PDF)

Diabetic equipment supplies benefits to change (PDF)

COVID-19 vaccine admin proceedure codes (PDF)

Medicaid Autism Services Family Flyer: Applied Behavior Analysis Services (PDF)

Jan 2023

NAMI Seminar (PDF)

Fall 2022 (PDF)

Summer 2022 (PDF)

Spring 2022 (PDF)

Provider notification COVID-19 waiver letter and attestation (PDF)

Provider notification 1312_PA Colony Stimulating Factors (PDF)

Provider Notification Prior Authorization guidance when ABHTX is Secondary (PDF)

PA removal code A6509 effective February 7, 2023 (PDF)

Removal of prior authorization requirement for preferred antipsychotics (PDF)

Benefit criteria to change for vaccine services effective September 1, 2022 (PDF)

Prior Authorization Criteria for Cervykti Begins 12/1 (PDF)

Billing and Appeal Reminders Provider Bulletin (PDF)

Provider Notification Commercial Payer ID (PDF)

Provider EVV Notice  Home Health Care Services Implementation Confirmed for Jan. 1 2024 (PDF)

Provider Notification for Specialized Medical EQP (PDF)

Provider Notification for Tezepelumab-ekko (Tezspire) (PDF)

Provider Notification for Negative Pressure Wound Therapy (PDF)

CHIP cost sharing for Covid-19 (PDF)

LTSS Matrix update provider notification effective December 1, 2022 (PDF)

LTSS Billing matrix notice December 2022 (PDF)

Provider Notification Aeppays

Provider Notification CT Scan for Lung Cancer (PDF)

Effective September 1, 2022, non-LMHA Providers May Deliver Mental Health Targeted Case Management (MHTC)and MentalHealth Rehabilitation (MHR) Services in FFS Medicaid (PDF)

CPW Case Management Services (PDF)

Provider notification - Injections PA (PDF)

AA and demographic provider notice (PDF)

HCS - Information Letter No. 2022-38 (PDF)

Provider notification – Linezolid injectable (PDF)

Mediciad Precertification Optimization (PDF)

Mediciad Precertification Optimization (PDF)

Mediciad Precertification Optimization (PDF)

OB Ultrasound Policy Update (PDF)

COVID MCO Table (PDF)

American Rescue Plan Act (ARPA) Home and Community-Based Services (HCBS) Provider Retention Payments (PDF)

Provider notification - CPT code updates  effective date of 07/10/2022 (PDF)

Provider notification - Push-Rim activated Power Assist Wheelchair PA change (PDF)

Provider notification - PA Pegfilgrastim change (PDF)

Provider notification - Collaborative Care Model (CoCM) (PDF)

Provider notification – Psych test evaluation cpt codes (PDF)

Provider notice - Mosquito repellent available as statewide benefit — (English (PDF) | Spanish (PDF))

Provider notice - Conduent paper claim address change (PDF)

PA Provider Notification - Injectables (PDF)

 PA Provider Notification- Psych Test Evaluations (PDF)

CHIP co-payments for MH/SUD outpatient office visits & Residential Services Prohibited as of July 1 (PDF)

CHIP office visit co-payments, updated reimbursement process (PDF)

Ambulance update (PDF)

New Covered Benefits and No longer needed PA (PDF)

April 25, 2022 Prior Authorization Update (PDF)

Injections Update Provider Notification (PDF)

Availity GIC Email Template (PDF)

Provider Notification - CPT cods for spinal proceedures (PDF)

SNIP Level Editing Provider Notice (PDF)

COVID Test Kits Notificaiton Letter (PDF)

ABA Services Notification (PDF)

Availity Provider Portal Update - No Faxing (PDF)

Dallas STAR Kids PA Edits Implementation Provider Notice (PDF)

Notice to physcians and providers (PDF)

Fall 2021 (PDF)

Summer 2021 (PDF)

Spring 2021 (PDF)

Winter 2021 (PDF)

CCP Prior Authorization Request Form (PDF)

Medicaid Web Portal Sunset Effective 1.1.22 (PDF)

Prior Auth - Provider Notification Effective 12.1.21 (PDF)

Hurricane Ida Emergency Expedited Application with Louisiana Medicaid (PDF)

Bulletin for CareWebQI Sunset (PDF)

Provider Notification: Exceptional Circumstance (PDF)

Antipsychotic Prior Authorization Information (PDF)

Provider bulletin - PPE and Respiratory Pathogens (PDF)

ABH of TX is Getting an Upgrade (PDF)

Personal Protective Equipment (PPE) Distribution (PDF)

Telemedicine (Physician-Delivered) and Telehealth (Non-Physician-Delivered) Services Extended through March 31, 2021

Prior Authorization RFI Changes (PDF)

RX AETNA PROVIDER NOTIFICATION New policy updates (Bamlanivimab, casirivimab, imdevimab) (PDF)

Revision to Nucala (mepolizumab) Prior Authorization Criteria (PDF)

Notice to Physicians and Providers (PDF)

Reminder: Provider Enrollment Revalidation Requirements (PDF)

Healthy Texas women member flyer — English (PDF) | Spanish (PDF)
 

Fall 2020 (PDF)

Spring 2020 (PDF)

Provider Notification Changes Peer-to-peer (PDF)

Pharmacy Network Changes effective January 1, 2021 (PDF)

Texas HHSC 2020 COVID-19 Impact Survey Questions (PDF)

Expanded services with Equian, Cotiviti and Optum (PDF)

How to Submit a Complaint (PDF)

Texas Health Steps Reminder (PDF)

ABH Prior Authorization Effective 9/1/20 (new) (PDF)

Survey to Identify Substance Use Screening and Referral Practices for Pregnant and Postpartum Women

New Policy Updates for STAR Kids and eviCore for Prior Authorization effective 09012020 (New) (PDF)

Project ECHO 
 

• Project ECHO Information (PDF)
• American Cancer Society Project ECHO Cover Letter (PDF)
• American Cancer Society Project Flyer (PDF)
• HPV Vaccination Project ECHO Continuing Education (PDF)

New Policy Updates Clinical Payment, Coding and Policy Changes 9/1/2020 (PDF)

New Policy Updates Clinical Payment, Coding and Policy Changes (PDF)

STAR, STAR Health: COVID-19 and Applicability of EPSDT for Some Adults in STAR and STAR Health (New) (PDF)

Housing Choice Survey

Data Quality Issues Experienced by MCOs via Texas Immunization Registry (PDF)

Instructions for Electronic Funds Transfer (EFT) Enrollment (PDF)

Instructions for Electronic Remittance Advice (ERA) Enrollment (PDF)

Beginning May 1, 2020, Medicare-Enrolled Speech-Language Pathologists May Apply to Enroll as Texas Medicaid Providers (PDF)

Aetna Better Health® of Texas Claim Submission Instructions Change Notice – Service Facility Address on NICU Claims (PDF)

Notice to Physicians and Providers (PDF)

ABH Electronic Authorization New Electronic Prior Authorization Submission Tool Quick Reference Guide (PDF)

Aetna Better Health of Texas’s Provider Web Portal (PDF)

Beginning December 14, 2019, Opioid Treatment Providers May Submit Texas Medicaid Enrollment Applications (PDF)

Clinical Laboratory Improvement Amendments (CLIA) requirements on Claim Submissions Effective 01-10-2020 (PDF)

Inform Providers 2012 American Dental Association Claim Form not to be used after Dec. 31, 2019 (PDF)

Eteplirsen to become a Benefit in the Home Setting Effective December 1, 2019 (PDF)

Providers Required to Use 2018 and 2019 American Dental Association Claim Forms by Jan. 1 (PDF)

Aetna Better Health® Webinar Series Schedule (PDF)

Inform Texas Health Steps Providers that the DSHS Laboratory Web Portal is Not Available by Nov. 18 (PDF)

Save the Date for FMSA Annual Training on Oct. 21 (PDF)

Congenital Syphilis Health Advisory (PDF)

Inform Providers About the Time Limit for Use of the 2012 American Dental Association Claim Form (PDF)

Medication Assisted Treatment Benefits to Change for Texas Medicaid November 1, 2019 (PDF)

Updated Version of the American Dental Association Claim Form Now Available (PDF)

Summary of smoking cessation benefits in Medicaid and CHIP (PDF)

DSHS public health notice

Diagnosis Code Guidelines-ICD-10 Excludes 1 Notes 06122019 (PDF)

Hello to Health ( English (PDF) | Spanish (PDF) )

Claim Filing Instructions Change Notice – Provider Taxonomy (PDF)

Reminder: Changes to Sterilization Consent Form, Instructions, and Denial Letter Effective April 26, 2019 (PDF)

LARC Notice (PDF)

Texas Partnership for Out of School Time (TXPOST) (PDF)

Important Guidance Regarding MCO LTSS Provider Enrollment - MCO Credentialing is Not Equivalent to Medicaid Enrollment (PDF)

HEDIS Results 2018 (CHIP) (PDF)

HEDIS 2018 Results (STAR) (PDF)

Final LTSS Enrollment Notification (PDF)

Acceptable and Not acceptable as an MSRP/Invoice (PDF)

Therapy Wait List (PDF)

Prior Authorization (PA) Change notice (PDF)

MCO LTSS Quick Tips (PDF)

Antibiotic Stewardship CME (PDF)

Antibiotic Stewardship News you can use (PDF)

Texas Credentialing Alliance Alert & Reminders about CVO Process & Availity Portal (PDF)

Updated Provider Information Change Form Now Available (PDF)

First PPECC Medicaid Enrolled Provider, and PPECC Type and Place of Service (PDF)

Aunt Bertha - Get information about local programs. Aunt Bertha makes it easy to get the help you need.

Aetna Provider Notification - Facility Emergent ER effective 06012018 (PDF)

WIC and Postpartum Depression resources (PDF)

Clarification for Providers Regarding MCO Therapy Guidance (PDF)

Prenatal Screening for Domestic Violence & Substance Use

Wound Equipment and Supply Benefits Change July 1 2018 (PDF)

Preventing Lead Exposure Provider Education

Access to Care Guidelines (PDF)

5-17-2018 Update Aetna Better Health Provider Letter – Delivery Claim Billing Effective Feb 1 2018 (PDF)

Dental Anesthesia – Clinical Payment, Coding and Policy Changes (PDF)

Opioid Strategy (PDF)

NICU Visit Policy Change rev (PDF)

CHIP Member Eligibility Now Available via EDI HIPAA X12 270 and 271 Transaction (PDF)

LOI Letter to Facility (PDF)

Private Duty Nursing Policy Language Clarification (PDF)

AIM Maternal Safety Bundles in Texas (PDF)

Texas AIM Flyer March Webinar (PDF)

ABH Delivery Claim Billing effective 2/1/2018 (PDF)

Delivery Group 1 – Full codes (PDF)

Mayo Clinic—Pathways to Physician Diversity: A National Summit 2018 Schedule (PDF)

Mayo Clinic Diversity Summit Flyer (PDF)

Update to the TMPPM Gynecological, Obstetrics and Family Planning Handbook for LARC and Immediate Postpartum LARC Devices

LARC Quick Course

HEDIS Training Webinar Series (PDF)

Small Alternative Device Alert (PDF)

Texas Resiliency and Recovery Utilization Management Guidelines (TRRUMG) (PDF)

HEDIS Training Webinar Series (PDF)

Project ECHO Training (PDF)

Practice requirements related to telemedicine services

CHIP Provider Reenrollment (PDF)

Private Duty Nursing Benefit Language Clarified for Texas Medicaid Effective January 1, 2018  (PDF)

Reminder Texas Health Steps Procedures and Documentation (PDF)

Child Developmental Screening and Surveillance Web Training (PDF)

Weight Assessment and Counseling for Nutrition and Physical Activity Measure for HEDIS – Billing Codes (PDF)

Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (PDF)

Medicaid Fraud Notice (PDF)

10-4-17 Upcoming CHIP Provider Enrollment Webinar (PDF)

TexasBenefitsCard.com Provider Portal Tutorial (PDF)

Breastfeeding Support Services to Change for Texas Medicaid on September 1 2017 (PDF)

Therapies Policy Changes FAQ (PDF)

Improved Access to Breast Pumps Effective September 1, 2017 for Texas Medicaid (PDF)

Texas Health Steps Provider Notice - DSHS Lab Specimens Hurricane Harvey (PDF)

Texas Medicaid Standing Order for Mosquito Repellent (PDF)

 Notice to Pharmacies: Mosquito Repellent Benefit (PDF)

Notice to Prescribers: Mosquito Repellent Benefit (PDF)

Physical, Occupational, and Speech Therapy Benefit Changes Effective September 1, 2017 (PDF)

Changes to the Texas Health Steps Therapeutic Dental Benefits (PDF)

Provider Notification of Unlisted Codes (PDF)

Letter to Hospitals, Facilities, Physicians for Clinical with notifications (PDF)

Obstetric delivery claim filing update (PDF)

Changes to Sterilization Consent Form and Instructions, Approval Process, and Denial Letter (PDF)

Mosquito Repellent Extension Notice to Providers (PDF)

Texas Health Steps Quick Reference Guide (PDF)

Zika Notice for Providers (PDF)

Zika Notice for Pharmacies (PDF)

MSI Announcement letter (PDF)

ADHD Provider Tip Sheet (PDF)

Re-enrollment Guidance for Provider (PDF)

Removal of Behavioral Health Prior Authorization Requirements (PDF)

CHIP Cost Sharing Requirements (PDF)

CMS 1500 Claim Form (PDF)

Humulin Pen Phase Out (PDF)

April 2014 Preventive Visit Incentives/Bexar (PDF)

March 2014 Preventive Visit Incentives/Tarrant (PDF)

February 2014 Preventive Incentives/Tarrant (PDF)

Provider Refund Notice (PDF)

Speech Therapy Policy Change (PDF)

Physical Therapy Policy Change (PDF)

Occupational Therapy Policy Change (PDF)

Change in CHIP IDs Letter (PDF)

Change in CHIP IDs HHSC Communication (PDF)

CHIP Cost Sharing Requirements (PDF)

 Methodist Hospital System of San Antonio Termination Letter (PDF)

Clarification of Reimbursement Rate Change for APRN/PA (PDF)

Methodist Hospital System of San Antonio Termination Reminder Letter (PDF)

ICM Grace Period (PDF)

Provider Rate Increase Delayed Notification (PDF)

Rate Reduction (PDF)

Modifiers for Deliveries (PDF)

Multiple Flu Tests (PDF)

ICD-10-CM Coding (PDF)

Special Investigative Units (PDF)

Additional 1% Reimbursement Reduction (PDF)

Immunization Administration Procedure Code Changes (PDF)

Grace Period Texas Health Steps Screening Tools (PDF)

Vitamins and Minerals Added to STAR Formulary (PDF)

Grandfathering of Anti-Depressants and Growth Hormones (PDF)

ACA PCP Rate Increase (PDF)

Stay up to date with all the policies and procedures from Texas Health and Human Services.