Custom Edit Implementation

Date: April 24, 2025

Attention: All Providers

Effective date: July 23, 2025

Call to action: The purpose of this communication is to inform providers and their designated clearinghouse of the custom edits that will go live on July 23, 2025.

How this impacts providers: The Custom edits that will be implemented were active in the legacy Change Healthcare Clearinghouse in February 2024. The edits being re-implemented are as follows.

Billing Taxonomy
- Billing Provider taxonomy needs to accompany the Billing Provider NPI.
Service Facility
- When place of service is anywhere other than home or office, the facility’s NPI must be present.
NDC
- NDCs will be validated against the quarterly NDC Crosswalk to ensure that each NDC is valid and in compliance with the most recent state-provided data. Please note: TCHP will be using the VDP (Vendor Drug Program) quarterly NDC-to-HCPCS Crosswalk.
Billing Provider 2ndry ID
- Atypical Provider ID (secondary provider identifier) and qualifier must be in the correct format.
Rendering Physician
- Claim must have the correct rendering provider taxonomy and NPI.
Attending Physician
- The physician’s first name, last name and NPI are required with the exception of Ambulance and Home Health claims.

Operational Support

Availity Customer Support (ACS) supports providers with all Availity Essentials Portal actions. Provider’s clearinghouse are welcome to contact Availity at 1-800-282-4548 for one of the reasons below. Availity call center is available Monday – Friday, 8am to 8pm EST. Examples include:

Portal registration
User access/ Account assistance
Transaction submissions
Portal error messages
Claim rejection

Texas Children’s Health Plan Call Center supports providers with all ‘data’ related provider inquiries. Providers can contact the Call Center at 832-828-1004 or toll-free at 1-800-731-8527. Examples include:

Claim denial
Benefit coverage details
Prior Authorization details
Claim payment questions
Network details

Next step for Providers: Providers should share this communication with their billing staff and clearinghouse.

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

For access to all provider alerts: www.texaschildrenshealthplan.org/provideralerts.