Update on Claim Submission Requirements for Institutional Claims

Date: April 8, 2021 Attention: All Providers Effective Date: April 16, 2021Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event. Call to action: Texas Children’s Health Plan (TCHP) would like to inform network providers that beginning April 16, 2021, Change Health Care (CHC) will require the following information on all UB04 (837I) institutional claims:

• Attending provider name- the individual who would normally be expected to certify and re-certify the medical necessity of the number of services rendered or who has primary responsibility for the patient’s medical care and treatment.
• National Provider Identifier (NPI) Number- NPI must be submitted unless the provider has an Application Programming Interface (API) assigned, which will be reported in Loop 2310A.

As a reminder, all claims must also include the following information:

• The most appropriate ICD-10-CM diagnosis code that represents the purpose for the service.
• The most appropriate Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) procedure code that represents the service provided.

How this impacts providers: Providers should verify that their claims are configured to be submitted with all of the required fields by the April 16, 2021 effective date. Claims missing some or all of the required information on or after April 16, 2021 may be rejected. Next steps for providers: Provider should share this communication with their billing staff. If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.For access to all provider alerts,log into: www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.