NEWS. TCHP offers health education classes in provider offices. May A publication of Texas Children s Health Plan

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1 Provider A publication of Texas Children s Health Plan NEWS May 2012 TCHP offers health education classes in provider offices Did you know that Texas Children s Health Plan (TCHP) case managers can host nutrition and fitness classes in your office? Topics include diabetes and obesity. These classes are available for all TCHP members. TCHP can offer your office staff flyers to help you promote the event. Call your provider relations representative today to schedule your next patient education class. ND Texas Children s Health Plan, Inc. P.O. Box , NB 8301 Houston, Texas NONPROFIT ORG. U.S. POSTAGE PAID PERMIT NO. 4 HOUSTON, TX

2 Medical Director Corner Dear Primary Care Provider, Texas Children s Health Plan (TCHP) is continuously looking for ways to provide our network of physicians with valuable resources to assist them in the care of our TCHP members. In the coming weeks, your Provider Relations Representative will deliver to you a CPT code pocket reference card, which will provide you with accurate coding guidelines at your fingertips. Dr. Angelo Giardino This pocket card can be referenced at the physician s convenience to ensure accuracy in the coding of multiple types of visits. The card includes guidelines for a new patient, established patient, office and outpatient consultation, initial inpatient consultation, initial hospital care, subsequent hospital care, hospital discharge, and critical care coding. TCHP s Audit and Compliance Department has found the most common mistakes made by physicians are lack of documentation in regard to history of present illness and documentation of all components of the visit to ensure that proper coding can be validated in the medical record. With this pocket card, you will be coding your claims correctly, you will have reminders for the needed components at each visit level, and you will be able to avoid the inconvenience of a compliance audit and possible confusing recoupments caused by incorrect coding of visits. We hope that you find this resource valuable in your busy practice. We thank you for your continued high-quality service you provide to our members. If we can be of any service to you, please do not hesitate to contact your Provider Relations Managers. Sincerely, Dr. Angelo Giardino Chief Medical Officer Stay connected with Texas Children s Health Plan Texas Children s Health Plan wants to stay connected with you. We have added a new sign up feature to our website. It s free and easy to sign up. Visit our website at and enter your address. Once you sign up, check your to confirm. Join our mailing list today! This is just another way for us to keep you informed about upcoming provider training sessions, program changes, and FREE events for our members

3 TCHP 2011 Member Satisfaction Survey scores show continuous improvement In 2007, Analytica was commissioned by Texas Children s Health Plan (TCHP) to conduct 5,000 interviews annually with a stratified random sample of members regarding satisfaction with their care. This year, our report presents the results from 2011 and compares those results to 2009, the year in which the same active, high volume physician s member panel were interviewed. Of the 3 overall measures, all were statistically significant. The average for likelihood of recommending went up from to , P=.037. The doctor s care average went up from 4.24 in 2009 to 4.40 in 2011, P=.001. The care from staff and office went up from 4.01 to 4.19, P=.000. For overall satisfaction with care from the physician, responses included Excellent (63.5 percent),very Good (18.4 percent), Good (14.3 percent), Fair (2.4 percent), and Poor (1.4 percent). For satisfaction with care from staff and office, the ratings were: Excellent (51.4 percent), Very Good (24.0 percent), Good (18.8 percent), Fair (4.1 percent), and Poor (1.8 percent). In terms of likelihood of recommending this physician to a friend or family member, responses included: Definitely Yes (84.2 percent), Possibly Yes (7.2 percent), Maybe (3.9 percent), Possibly Not (1.5 percent), and Definitely Not (3.2 percent). Thus, 95.3 percent are on the yes side of recommending this doctor to their friends and family. Examination of the performance measures reveals that survey questions related to the doctor receive higher ratings; questions relating to wait time and return of phone calls receive the lowest ratings. Another item that stands out because of its relatively lower performance was the courtesy and friendliness of the receptionist. The item having the greatest impact on a physician s performance was courtesy and friendliness doctor, followed by office waiting room time. Next in order of importance was the doctor listened to questions, followed by appointment date and time. Member satisfaction surveys for 2012 will survey those physicians last surveyed in If you or your office staff would like to have additional training, your Provider Relations Representative is available to do office staff presentations on Through the Patient s Eyes, a customer focused presentation. To learn more call Provider and Care Coordination, or toll-free at

4 OB/GYN CHIP perinatal services available through TCHP On March 1 st, Texas Children s Health Plan started offering CHIP perinatal services. CHIP perinatal is part of the Children s Health Insurance Program (CHIP). CHIP perinatal provides prenatal care for the unborn child of women who can t qualify for Medicaid. Benefits for CHIP perinatal are substantially different from STAR Medicaid. When a CHIP perinatal member joins TCHP, the entire family, if eligible, is enrolled in the Health Plan. There are no copayments for CHIP perinatal members. Below is a brief overview of the CHIP perinatal services offered to our members and how providers should bill these services. What are the benefits for a CHIP perinatal member? Eligibility is for 12 months from date of enrollment, the newborn carries the eligibility with them upon birth for the full 12 months of coverage. Up to 20 prenatal visits. o First 28 weeks of pregnancy 1 visit every 4 weeks. o 28 to 36 weeks of pregnancy 1 visit every 2 to 3 weeks. o 36 weeks to delivery 1 visit per week. o Additional prenatal visits allowed if medically necessary. Some laboratory testing, assessments, planning services, education, and counseling. Prescription drug coverage based on the current CHIP formulary. Hospital facility charges and professional services charges related to the delivery. Preterm labor that does not result in a birth and false labor are not covered benefits. o For women with income between 186 to 200 percent FPL: Hospital facility charges paid through CHIP. Professional service charges paid through CHIP. o For women with income at or below 185 percent FPL: Hospital facility charges paid through Emergency Medicaid. (A client must apply and be determined eligible for Emergency Medicaid for a claim to be paid to a Medicaid provider.) Professional service charges paid through CHIP. To learn more about CHIP benefits for the unborn child call TCHP at What services are not covered? Some of the services not covered include: A mother s hospital visit for services not related to labor with delivery, such as a broken arm or false labor. (She can apply for Emergency Medicaid to cover the hospital visit, but must meet the income limits.) Specialty treatment for the mother, such as care for asthma, heart conditions, mental health, or substance abuse. Does the perinatal mother receive postpartum visits? Two postpartum care visits within 60 days of delivery are covered under CHIP perinatal. Providers will bill these visits as they normally would bill TCHP for post partum care using the office E&M code and diagnosis codes V24-V24.2 How do physicians bill CHIP perinatal services? To send claims to TCHP electronically Emdeon and Availity payor ID Legacy payor ID 76048C To send claims to TCHP via U.S. mail Texas Children s Health Plan PO BOX Houston, TX Continued on page

5 OB/GYN CHIP perinatal continued. Appeals should be submitted using our appeal form located at Mail appeal and supporting documentation to: Texas Children s Health Plan Attn: Appeals PO Box Houston, TX ` How do facilities bill CHIP perinate? CHIP perinatal newborns born in group A, 185 percent FPL and below are billed to the new STAR Medicaid HMO once eligibility has been determined by the State and an HMO is chosen. TCHP is not responsible for CHIP Perinate Group A newborn claims. CHIP perinatal newborns born in group B, percent FPL, are billed to TCHP immediately. The CHIP perinatal newborn is eligible for full CHIP benefits with no copayments required. For CHIP Perinate group A Facility claims are billed to TMHP. For CHIP Perinate group B Facility claims are billed to TCHP. How do I check eligibility? Check eligibility with TCHP by using our Provider TouCHPoint portal 24 hours a day at www. TexasChildrensHealthPlan.org/providers. To enroll in Provider TouCHPoint call , or toll-free at Call the TCHP Provider Hotline at and choose eligibility or benefits options to speak with a Member Services representative Monday through Friday from 7 a.m. to 6 p.m. If you are a contracted provider with TCHP and have registered an account with us, you can receive a secured with member eligibility 24 hours a day through Telephone TouCHPoint at To learn more on CHIP perinatal visit: InfoForProvidersAndCBOs.htm Are you using Provider TouCHPoint? It s easy to register for Provider TouCHPoint. Provider TouCHPoint users get 24-hour access to member eligibility, payment of claims, electronic remittance advice, and member panel information. To sign up, call Provider Relations and Care Coordination at

6 Providers can expect appointment accessibility and after hours surveys Texas Children s Health Plan (TCHP), in accordance with the Health and Human Services Commission (HHSC), conducts an annual phone survey of its provider network to ensure members are able to schedule appointments with their primary care providers in a timely manner. All TCHP providers should inform their staff that they will receive a phone call from the TCHP Provider Relations Department in the month of May. The brief survey measures each office s ability to comply with the established appointment accessibility standards. The chart to the right lists the survey standards. Provider Relations will also call primary care providers after normal business hours to ensure that access to medical care is available 24 hours a day, 7 days a week. TCHP guidelines require primary care providers to have an answering service that is able to reach the physician, an answering machine message indicating how to reach the physician or other provider(s) accepting calls. Providers should return pages or messages within 30 minutes. To learn more about the TCHP Appointment Accessibility or After Hours Survey call Provider and Care Coordination at or toll-free at Appointment Type Emergency care visit Urgent care visit, including urgent specialty care Routine primary care Newborn care Adult preventive care Initial outpatient behavioral health visit Existing members over 36 months annual checkup within 364 days of birthday New member visit Pre-natal care, except for high-risk pregnancies or new Members in 3rd trimester High-risk Pregnancies or new Members in 3 rd trimester HHSC Standard Immediate appointment or refer to ER Within 24 hours of request Within 14 days Within 14 days Within 90 days Within 14 days Within 364 days of birthday Within 90 days Within 14 days Within 5 days Performance Management Standards for ADHD treatment The Texas Department of State Health Services(DSHS) has adopted the NCQA/HEDIS quality measures for ADHD for Texas Chidren s Health Plan members. The Performance Management Standards come from the National Committee on Quality Assurance (NCQA) through its reporting of the Healthcare Effectiveness Data and Information Set (HEDIS) and addresses performance measures in both the private and public health programs. A link to the 2012 Physician Quality Management Standards can be found at: ug%3d&tabid=1415 Starting in September 2012, Texas Children s Health Plan and DSHS will be monitoring important aspects of care for children diagnosed with ADHD, as follows: During the initiation phase (start of medication) children should be seen for follow up at least once in the first 30 days. During the next stage (maintenance), the child should receive 2 follow-up visits within the subsequent 9 months. TCHP will work collaboratively with you to achieve success. During the next several months, Providers and Care Coordination and Case Managers will meet with you and provide support materials including a toolkit for use in your practice along with patient education materials. Additionally, TCHP will provide the names of your patients with this diagnosis and for whom prescriptions were provided so as to assist you in follow-up planning

7 For Your Office Staff Changes to Texas Children s Health Plan ID Cards On March 1st, Texas Children s Health Plan s (TCHP) contract with the Health and Human Services Commission (HHSC) state of Texas to provide quality health coverage through STAR Medicaid and CHIP required changes to the TCHP member ID cards. Now there are 5 slightly different versions of the TCHP ID card. All 5 cards, STAR, STARDent, CHIP, CHIP Perinate Group A and CHIP Perinate Group B, now refer to our Pharmacy Benefit Manager (PBM), Navitus, with their contact information. CHIP perinate members will show either Group A or Group B in the upper right hand portion of their ID card. Providers will find billing information on the back of the ID card for each group type. Members received these ID cards March 1st, and were instructed to begin using them immediately. STAR STARDent Group A or Group B CHIP CHIP Perinate Medicaid transportation assistance change for STAR members Effective March 15th, the Medical Transportation Management phone number has changed. The new toll-free number is Medical Transportation Management provides free rides to health care appointments for TCHP STAR members. Members must call 2 business days before the appointment. TCHP members will need to have their medicaid number, doctor s name, address, phone number, and date and purpose of the visit

8 For Your Office Staff Congratulations to our 2012 contest winners We received more than 100 drawings from Texas Children s Health Plan members for our 2012 T-shirt design contest. This year we have picked 3 winners. We placed 11-year-old Rigoberto Jimenez, Jr. and 14-year-old Ashley Tran s artwork on the front of the t-shirt. We placed 15-year-old Patricia Palma s artwork on the back. Provider News Provider News is published quarterly by Texas Children s Health Plan Texas Children s Health Plan All rights reserved. P.O. Box , NB /

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