• HHSC Off Cycle MCO Notice 01.04.2021

• Availity Portal eligibility and benefits (Additional benefit notes and digital member ID Cards)
• HEDIS 2020: Medicaid Measure Update and Summary of Changes from NCQA

• 2020 affirmative statement concerning utilization management decisions
• Acquisition of Beacon Health Options
• August 2020 Clinical Utilization Management (UM) Guidelines
• August 2020 Medical Policies and Utilization Management Guidelines update
• Availity Provider FAQ
• Change Healthcare Medical Attachment Functionality FAQ
• Clinical Criteria Web Posting September and October 2020
• Clinical Edit Form for Symdeko
• Clinical Edit Form for Taltz
• Clinical Practice Guidelines Matrix
• Consumer Assessment of Healthcare Providers and Systems® (CAHPS) 101
• Controlling High Blood Pressure (CBP)
• Emergency Room Autopay List of Diagnosis Codes
• February 2020 Clinical Utilization Management (UM) Guidelines Update
• February 2020 Medical Policies and Clinical Utilization Management Guidelines update
• Global 3M19 Medical Policy and Technology Assessment Committee Prior Authorization Requirement Updates
• HealthyTexasWomen
• Incentive delay notice
• Incorrect Claims Payments Alert
• LARC Devices Reminder
• May 2020 Clinical Utilization Management (UM) Guidelines Update
• May 2020 Medical Policies and Clinical Utilization Management Guidelines update
• MCG care guidelines — 24th edition
• MCS Notification of Delivery Form
• Medical Drug Benefits Clinical Criteria Updates (February 2020)
• Medical Drug Benefits Clinical Criteria Updates (March 2020)
• Medical Drug Benefits Clinical Criteria Updates (May 2020)
• Medical Drug Benefits Clinical Criteria Updates (June 2020)
• Medical Drug Benefits Clinical Criteria Updates (August 2020)
• New Baby, New Life Provider Booklet
• New behavioral health discharge call-in line
• New Emergency Room Requirement for Hospital and Autopay List of Diagnosis Codes
• New MCG Care Guidelines 24th edition Viral Illness
• November 2019 Medical Policies and Clinical Utilization Management Guidelines update
• OBGYN Ultrasound Update
• Policy Reminder – Nurse Practitioner and Physician Assistant Services, Professional
• Prenatal Ultrasound Diagnosis Codes
• Preventative Health Guidelines- English
• Preventative Health Guidelines- Spanish
• Prior authorization requirements for angiographic evaluation of stenotic or thrombosed dialysis circuits
• Prior authorization requirements for E0482
• Provider Digital Engagement
• Providers using Change Healthcare can now receive and respond to medical record requests for postpay audit via the Assurance Attach Assist Module
• Racial Trauma Forum Invitation
• Submit behavioral health authorizations via our online Interactive Care Reviewer tool
• Texas Health Steps and extended ophthalmoscopy
• Transition to AIM small joint guidelines
• TX Dell Children Availity Provider Article
• Updates to AIM Clinical Appropriateness Guidelines for Advanced Imaging

• CS Health Advisory Notice
• Data Quality Issues Experienced by MCOs via Texas Immunization Registry
• Delegated Psychological Services
• DSHS Laboratory Request Form
• DSHS Laboratory Web Portal Notice
• Opioid Treatment Providers
• Smoking and Tobacco Use Cessation Counseling Benefits Change
• Summary of Tobacco Cessation Benefits
• Tobacco Use Cessation Services Provided in a Group Setting
• Updated American Dental Association Claim Form
• Webinar on Writing Functional Therapy Goals
• Updated Version of the American Dental Association Claim Form
• Zika Virus Testing Update

• Addition of Bamlanivimab as Texas Medicaid Benefit
• Healthy Texas Women Plus
• Healthy Texas Women (HTW) Plus Services Available September 1, 2020
• Help Youth Formerly in Foster Care Maintain Their Medicaid
• How to Submit a Complaint as a Medicaid Provider
• Hurricane Delta and Laura Information for Medicaid Providers
• Learning Opportunity Pediatric Brain Health Summit on November 5-6 2020
• Services Not Covered in the Texas Medicaid State Plan
• Survey to Identify Substance Use Screening and Referral Practices for Pregnant and Postpartum Women
• Telemonitoring Benefit Changes for Texas Medicaid
• Training Module Immunization

• August 2019 Clinical Utilization Management (UM) Guidelines Update
• Changes to Mental Health Rehabilitative Services and Targeted Case Management Prior Authorization/Notification Requirements
• Clinical Criteria Web Posting July 2019
• Clinical Criteria Web Posting Q2 2019
• Clinical Criteria Web Posting September 2019
• Clinical Criteria Web Posting November 2019
• Clinical Criteria Web Posting December 2019
• Clinical Edit Form for Emflaza
• Clinical Edit Form for Emgality
• Clinical Edit Form for Synagis
• Clinical Edit Form for Tadalafil
• Clinical Edit Form for Victoza
• Clinical Laboratory Improvement Amendments
• Clinical Practice Guidelines and Preventive Health Guidelines-Update
• Clinical Practice Guidelines Matrix
• Coding tip for psychological and neuropsychological testing
• Disease Management can help you care for patients with chronic health care needs
• EDI Gateway Migration
• Enhanced Claim Payment Dispute Process
• Guidelines Update for Therapy Precertification Requests
• Healthy Rewards Provider Flier
• Medicaid Span of Coverage
• Medical Policies and Clinical Utilization Management Guidelines Update
• New Clinical Guideline: Pneumatic Compression Devices
• November 2019 Clinical Utilization Management (UM) Guidelines Update
• P4Q Provider Incentive Plan
• Prenatal Aspirin for the Prevention of Preeclampsia
• Prepayment Clinical Validation Review Process
• Prior Authorization Requirements Changes Effective November 1, 2019
• Prior Authorization Form for Emflaza
• Prior Authorization Form for Emgality
• Prior Authorization Form for Symdeko
• Prior Authorization Form for Synagis
• Prior Authorization Form for Tadalafil
• Prior Authorization Form for Taltz
• Prior Authorization Form for Victoza
• Prior Authorization Requirements for Interferon beta-1a
• Prior Authorization Requirements for Subcutaneous Implantable Defibrillator System
• Prior Authorization Requirements for Sublocade
• Prior Authorization Requirements for Somatrem
• Prior authorization requirements: new 2020 codes for coverage and precertification
• Prior Authorization Update for Physician Order Requirements
• Sports Physical and Annual Checkups
• Utilization Management Affirmative Statement concerning utilization management decisions

Asthma is a long-term condition that makes it hard to get air into the lungs. Asthma may cause wheezing, tightness in the chest, shortness of breath, and coughing.

We can give you an asthma action plan for you and your health-care provider to complete. This will help monitor your condition, stay away from your triggers, and manage your medication (meds).

Learn more:

Asthma

Know Your Triggers

Asthma Attack

Asthma Action Plan

Bipolar disorder is a brain disorder that can cause unusual changes in mood, energy and activity level, and make it hard to carry out day-to-day tasks.

It can feel uneasy to learn you’re living with bipolar disorder, so we’re here to help. With proper treatment and support, you can enjoy a healthy, happy and productive life.

Learn more:

Bipolar Disorder

Symptoms

When to Call a Doctor

COPD is a condition in which damage to the lungs has caused the airways to change shape and feel partly blocked. This makes it hard to breathe.

We can help you learn to breathe easier to possibly improve your quality of life. We’ll help you learn how to use inhalers, spacers, nebulizers, and other devices, along with other skills for living with COPD.

Learn more:

COPD

COPD: Learning to Breathe Easier

Taking care of your heart is one of the best things you can do for your health. The heart pumps blood to the whole body. Having CHF means the heart can’t pump as hard as it should.

We can help you understand CHF better. That way, you and your health-care provider(s) can work together to help you feel your best.

Learn more:

Heart Failure

Symptoms

When to Call a Doctor

Your heart is only the size of a fist, but it’s one of the most important muscles in your body. Arteries throughout the body supply blood to your heart. When those arteries are blocked, and blood flow to the heart is reduced, it causes CAD.

We can help you with tips and tools, like making good food choices and following up with your doctor to keep your CAD in check.

Learn more:

Coronary Artery Disease (CAD)

Symptoms

Health tools

When to Call a Doctor

If you’re living with diabetes, you’re not alone. Diabetes happens when your body’s blood sugar (the amount of sugar in the blood) levels are usually higher than normal. It means there’s a problem making enough of a hormone called insulin, or your body isn’t using insulin like it should.

We can help you lower your risk of complications (problems or issues) and make your quality of life better.

Learn more:

Type 1 Diabetes

Type 2 Diabetes

Taking Care of Your Feet

Healthy Eating Tips

Human immunodeficiency virus (HIV) is a virus that attacks the immune system (the body’s natural defense against illness). It makes it hard for the body to fight infection and disease. If HIV isn’t treated, it can lead to AIDS. AIDS stands for acquired immunodeficiency syndrome. It is the last stage of the HIV virus.

We’re here to help you with simple steps for living with HIV/AIDS. Taking your medications the right way, eating healthy, staying active, and following your treatment plan can make a difference.

Learn more:

HIV (Human Immunodeficiency Virus) Infection

AIDS

Symptoms

Health Tools

Hypertension is also called high blood pressure. Blood pressure is the amount of force it take for your heart to pump blood through your body. When your blood pressure is high, it can lead to other health problems.

We can help you make short- and long-term goals that will help you manage your blood pressure.

Learn more:

High Blood Pressure

Symptoms

What Increases Your Risk

Everyone feels blue or sad some of the time, but these feelings don’t last very long. When a person has major depressive disorder (MDD or clinical depression), these feelings don’t go away easily. They can get in the way of your everyday life.

Depression is common and a real illness. The important thing to know is that it can be treated. We’re here to help you find resources in your area or help you talk with your family or caregiver about MDD.

Learn more:

Depression

Symptoms of Depression

Kids and teens can also have major depressive disorder (MDD or clinical depression).

We can help kids and teens talk with their families and health-care providers about MDD, get treatment, and live a healthier life.

Learn more:

Depression in Children and Teens

Schizophrenia is a behavioral health disorder that affects a person’s thoughts, feelings, emotions, decisions, and actions. Some even have a hard time with focusing and memory loss. It can get in the way of daily life.

We’re here to help you learn how to manage schizophrenia with medication, treatment, and support.

Learn more:

Schizophrenia

Symptoms

Schizophrenia: When Hospital Care is Needed

When to Call a Doctor

Substance use disorder is a disease that leads to the use of drugs, alcohol, or other substances in a way that causes problems for your health or in your life.

We can help those with substance use disorder work together with their health-care provider(s) to talk about treatment options (choices of ways to get better) and finding local community programs and resources.

Learn more:

Substance Use Disorder

Treatment

For Family and Friends

When to Call a Doctor

Any Dell Children’s Health Plan member with any of the health conditions listed can participate in a DM program. Our DM case manager can talk with you about your health history and health goals, and work with you to offer strategies and support so you can live well.

They can also offer educational materials and tools for weight management and tobacco cessation (how to stop using tobacco, like quitting smoking).

Members, you’ll get a letter welcoming you to a DM program, if you qualify. Or, call us toll free at
1-888-830-4300 (TTY 711) from 8:30 a.m. to 5:30 p.m. Central time, Monday through Friday.

When you call, we’ll:

• Set you up with a DM case manager to get started
• Ask you some questions about your or your child’s health
• Start working together to create your or your child’s plan

You can also email us at dl-txdelladvocate@anthem.com.

Please be aware that emails sent over the internet are usually safe, but there is some risk third parties may access (or get) these emails without you knowing. By sending your information in an email, you acknowledge (or know, understand) third parties may access these emails without you knowing.

You can choose to opt-out (we’ll take you out of the program) of the program at any time. Please call us toll free at 1-888-830-4300 (TTY 711) from 8:30 a.m. to 5:30 p.m. Central time, Monday through Friday to opt-out. You may also call this number to leave a private message for your DM case manager 24 hours a day.

When you join a DM program, you have certain rights and responsibilities. You have the right to:

• Get details about us, such as:
  • Programs and services we offer
  • Our staff and their qualifications (skills or education)
  • Any contractual relationships (deals we have with other companies)
• Opt-out of DM services
• Know which DM case manager is handling your DM services and how to ask for a change
• Get support from us to make health-care choices with your health-care providers
• Ask about all DM-related treatment options (choices of ways to get better) mentioned in clinical guidelines (even if a treatment is not part of your health plan), and talk about options with treating health-care providers
• Have personal data and medical information kept private
• Know who has access to your information and how we make sure your information stays secure, private, and confidential
• Receive polite, respectful treatment from our staff
• Get information that is clear and easy to understand
• File complaints to Dell Children’s Health Plan by calling 1-888-830-4300 (TTY 711) toll free from 8:30 a.m. to 5:30 p.m. Central time, Monday through Friday and:
  • Get help on how to use the complaint process
  • Know how much time Dell Children’s Health Plan has to respond to and resolve issues of quality and complaints
  • Give us feedback about the DM program

You also have a responsibility to:

• Follow the care plan that you and your DM case manager agree on
• Give us information needed to carry out our services
• Tell us and your health-care providers if you choose to opt-out (leave the program)

Disease Management does not market products or services from outside companies to our members. DM does not own or profit from outside companies on the goods and services we offer.

For a written version of your DM rights and responsibilities or information on this website, please print this page or call Member Services.

• 10-4-17 Upcoming CHIP Provider Enrollment Webinar
• 2018 Mosquito Repellent Standing Order
• AIM Maternal Safety Bundles n Texas Informational Sheet
• Benefit Update for Early Childhood Intervention for Texas Medicaid
• Breast Pump Notification Sept. 2017
• CHIP Member Eligibility EDI 270/271 Training
• CHIP Texas Medicaid & Healthcare Partnership Enrollment Notice
• Complete Rate Changes and Updates for Medicaid Therapy Services Eff 09.01.17
• Delayed Implementation for Required NPI of Rendering Provider
• HHSC Guidance on the Provision of Therapy
• HHSC Guidance on the Provision of Therapy Update (Clarification)
• HHSC Notice for Therapy Services
• HHSC Therapy Notification Update
• Hurricane Harvey – CHIP Copayments Notice
• Hurricane Harvey- Frequently Asked Questions
• Mayo Clinic Diversity Summit Flyer
• Mayo Pathways Diversity 2018
• Medicaid Fraud Letter to Providers
• Medicaid Fraud Provider Notice
• Mental Health Screening THSteps
• Neonatal Billing Requirements
• New Definition of Individual Speech Therapy Encounter
• Notice to Pharmacies: Mosquito Repellent Benefit
• Notice to Prescribers: Mosquito Repellent Benefit
• Prenatal Screening for Domestic Violence and Substance Abuse
• Postpartum Depression Screening THSteps
• Private Duty Nursing Benefit Language Clarified for Texas Medicaid
• Provider Types and Places of Service Changes for Physical, Occupational and Speech Therapy for All Ages for Texas Medicaid Sept. 1
• Special Supplemental Nutrition Program for Women, Infants and Children (WIC)
• Telemedicine and Telehealth Services Benefit Policy Language Update
• Texas AIM Flyer March Webinar
• Texas Health Steps Clinical Record Review Tool
• Texas Health Steps Clinical Record Review Tool – Alternate Version
• Texas Health Steps Improvement Letter
• Texas Health Steps Regional Provider Relations Representatives Contact List
• Texas Health Steps Therapeutic Dental Benefits Change Notice
• Third Party Liability and Recovery Guidance
• THSteps Therapeutic Dental Benefits to Change for Texas Medicaid July 1, 2017
• THSteps Therapeutic Dental Benefits Update
• Webinar on Writing Functional Therapy Goals
• Wound Care Equipment and Supply Benefits Change
• Zika Care Connect FAQ
• Zika Care Connect Overview

• 2018 Utilization Management Affirmative Statement
• Adoption Assistance or Permanency Care Assistance Managed Care Expansion
• Category II HEDIS Coding Tips
• Chimeric antigen receptor T-cell therapy requires prior authorization for all places of service
• CHIP Copay Changes
• CHIP Formulary Prior Auth Implementation – November
• CHIP Formulary Prior Auth Implementation – December
• Custom Shower Chairs Prior Authorization
• Dell Children’s Health Plan adopts Milliman Care Guidelines
• Eight Injectable Drugs Will Require Prior Authorization
• Electrical Stimulation Device to Require Prior Authorization
• Electronic Data Interchange Gateway Update
• Electronic Data Interchange (EDI) Update
• Elotuzumab to Require Prior Authorization
• Guidelines Update for Processing Therapy Precertification Requests
• January 2018 Medical Policies and CUMG Updates
• Lower extremity vascular intervention codes require prior authorization
• March 2018 Medical Policies and CUMG Updates
• Member Appeal Process Changes Notice to Providers
• Medical Policies and Clinical Utilization Management Guidelines – January 2018
• Medical Policies and Clinical Utilization Management Guidelines – March 2018
• Medical Policies and Clinical Utilization Management Guidelines update – May 2018
• Medical Policies and Clinical Utilization Management Guidelines Update – November 2018
• Miscellaneous Durable Medical Equipment Billing Guidelines
• Neonatal Level of Care Designation Required
• Non-Emergency Ambulance Prior Authorization Update
• Normal Newborn Diagnosis-Related Group Claims Processing Update
• Notification of Joint Venture
• Overpayment Identification and Refund Requirements
• P4Q Provider Incentive Plan
• Post-Payment Reviews of Distinct Procedural Service Modifiers
• Prenatal and Postpartum Outreach Initiatives
• Prior Authorization Requirement Update for Mylotarg
• Prior Authorization Requirements for Cabazitaxel
• Prior Authorization Requirements for Darzalex Drug
• Prior Authorization Requirements for Injectable/Infusible Drugs: Mepolizumab (Nucala) and Reslizumab (Cinqair)
• Services Requiring Prior Authorization
• Spinraza Clinician-Administered Drug Prior Authorization Requirements
• Update Regarding Appointment Availability Standards
• Update to Ordering/Prescribing/Referring Claim Submissions
• What Matters Most: Improving the Patient Experience CME

El Programa de Seguro Médico para Niños (CHIP) es una cobertura de cuidado de salud para personas que no califican para Medicaid pero que no pueden pagar un seguro de salud privado.

CHIP cubre a los niños desde el nacimiento hasta los 18 años de edad por estos servicios:

• Cuidado médico
• Medicamentos recetados
• Cuidado dental
• Cuidado de la vista
• Salud del comportamiento

CHIP Perinatal cubre a las mujeres embarazadas y nuevas mamás.

Cuota de inscripción

• La cuota se basa en los ingresos de la familia. Algunas familias deberán pagar $35 o $50 al año para inscribirse, pero las familias de menores ingresos no pagan nada.

Copagos

• Los copagos se basan en los ingresos de la familia.
• Las familias de menores ingresos tendrán copagos entre $0 y $5.
• Las familias de mayores ingresos tendrán copagos entre $10 y $35.

No hay cuotas de inscripción ni copagos para los miembros de CHIP Perinatal.

Los beneficios de CHIP se deben renovar cada 12 meses. Renueva tus beneficios.

Visita YourTexasBenefits.com para más información sobre CHIP.

STAR Medicaid provee cobertura de cuidado de salud para niños desde el nacimiento hasta los 20 años de edad. También se llama Medicaid para Niños. Cubre niños, mujeres embarazadas y algunos jóvenes que estuvieron en hogares de crianza en el pasado.

Cada plan tiene:

• Un médico de cuidado primario de tu elección
• Un amplio grupo de especialistas
• Terapeutas
• Clínicas
• Hospitales

Algunos servicios incluyen:

• Cuidado médico
• Medicamentos recetados
• Cuidado dental
• Cuidado de la vista
• Salud del comportamiento
• Servicios perinatales

No hay cuotas de inscripción ni copagos.

Los beneficios de STAR Medicaid se deben renovar cada 12 meses. Renueva tus beneficios.

Visita YourTexasBenefits.com para más información sobre STAR Medicaid.

Es posible obtener cobertura perinatal de CHIP si todos los siguientes aplican en tu caso:

• Estás embarazada
• Eres residente de Texas
• No tienes seguro
• No puedes obtener Medicaid

La cobertura de CHIP Perinatal es para tu bebé que no ha nacido y cubre:

• Hasta 20 visitas durante el embarazo
• Medicamentos recetados
• Costos del parto
• Dos visitas al doctor para la mamá después del parto

Chequeos médicos regulares, vacunas y prescripciones para tu bebé Es posible que tu niño también pueda continuar la cobertura bajo el programa CHIP.

Una mujer embarazada con poco o ningún ingreso puede recibir beneficios de Medicaid durante el embarazo y hasta dos meses después del parto si cumple con ciertos requisitos de ingresos.

Consulta nuestros Beneficios para mamás embarazadas y nuevas.