HHSC Adopts Proposed Payment Rates for Attendant Services in Various Programs

Date: September 28, 2023

Attention: Providers of the programs referenced in this notice

Effective date: September 1, 2023

Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective for dates of service on or after September 1, 2023, reimbursement rate changes and updates for procedure codes presented at a public rate hearing on July 11, 2023, will be implemented. The adopted payment rates, effective September 1, 2023, can be accessed on the Provider Finance Department (PFD) webpage.

The following topics were covered at the public rate hearing:

• Special review for:
  • Ambulance Services
  • Birth and Women’s Health Services
  • Evaluation and Management
  • Personal Care Services
  • Private Duty Nursing

How this impacts providers: For Fee-for-Service claims, providers should continue to bill using their normal billing process. Individual providers require no additional action in terms on how to submit claims. TCHP is actively working to update our system. As a reminder, TCHP has 60 days to implement and reprocess claims associated with the fee schedule updates according to the Uniform Managed Care Terms and Conditions (UMCC). Providers do not need to appeal claims, as we will automatically reprocess claims once the fee schedule updates have taken place.

Next step for Providers: Providers should review the adopted payment rates and be on the lookout for additional communication once the new rates have been applied to the TCHP claims processing system.

If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org.

For access to all provider alerts,log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.