[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-288733-105":53,"doc-detail-288733-en":130},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":123,"head_meta":125,"extra_data":127,"updated_unix":129},105,"en","provider-network-news-pchp-prior-authorization-requirement-update","Provider Network News - PCHP Prior Authorization Requirement Update","","PCHP provides a provider network notice updating prior authorization requirements following an ad hoc review of services. It states the notice is for update notification only and does not confirm benefit coverage. Prior authorization is required for requests exceeding Texas Medicaid benefit limitations, and non-covered or unauthorized services will not be reimbursed. It includes submission methods, effective dates, and changes to CPT/HCPCS codes on the PCHP Prior Authorization List, plus medical necessity documentation requirements.",{"@graph":63,"@context":122},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":41,"@type":70,"position":76},"https://docshare.wps.com/template/letters/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/provider-network-news-pchp-prior-authorization-requirement-update/288733/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/provider-network-news-pchp-prior-authorization-requirement-update/288733.png","ImageObject",442,249,{"name":88,"@type":89},"Jake","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-05","2026-09-17",true,{"@type":98,"interactionType":99,"userInteractionCount":47},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114,118],{"name":105,"@type":106,"acceptedAnswer":107},"What does the PCHP prior authorization update notice mean for coverage decisions?","Question",{"text":108,"@type":109},"The notice is for notification only and does not determine whether the benefit is covered by PCHP.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"How is a prior authorization request submitted to PCHP?",{"text":113,"@type":109},"Requests can be submitted via the PCHP Provider Portal or by fax, including separate numbers for inpatient prior authorization requests.",{"name":115,"@type":106,"acceptedAnswer":116},"What information is required to initiate the prior authorization process under UMCM 3.22?",{"text":117,"@type":109},"Essential items include member name, member number/Medicaid number, date of birth, requesting provider details (including NPI), requested service codes (CPT/HCPCS/CDT), requested start/end dates, and quantity of service units.",{"name":119,"@type":106,"acceptedAnswer":120},"When must prior authorization requests include documentation for medical necessity?",{"text":121,"@type":109},"Prior authorization requests should include supporting clinical documentation demonstrating medical necessity, such as test results, consultations and progress notes, history and physicals, medication records, and inpatient/emergency room documentation.","https://schema.org",{"og:url":78,"og:type":124,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":126,"canonical":78},"index,follow",{"doc_id":128,"site_id":56},288733,1790049884,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":88,"user_avatar":133,"doc_module":9,"category_id":40,"category_name":41,"doc_title":59,"doc_description":61,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":47,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":73,"language":139,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":61,"update_tm":143,"read_time":9},962084928904,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","Provider Network News  \nJuly 22, 2026  \nPCHP Prior Authorization Requirement Update  \nAdhoc Review: 7/20/2026  \nEffective date of all prior authorization removals, addendums, and adds in this notice: 9/1/2026  \nSummary  \nPCHP has completed an ad hoc review of all services requiring prior authorization. This Provider Network News alert is notification only of updatesand does not determine if the benefit is covered by PCHP. For specific CPT codes requiring prior authorization by PCHP, please review PCHP’s Prior Authorization List located at Providers.  \n[ParklandHealthPlan.com/Prior-Authorization](ParklandHealthPlan.com/Prior-Authorization). Policy Updates: Prior authorization is required for all service requests over the benefit limitations within the Texas Medicaid Provider Procedures Manual. Reminder: A request for prior authorization is not a guarantee of payment. Unauthorized services will not be reimbursed.  \nWays to Submit a Prior Authorization Request to PCHP  \nPCHP Provider Portal:  \n[Essentials.Availity.com](Essentials.Availity.com)  \nFax Prior Authorization Requests:  \n• Fax Number: 214-266-2085  \n• Toll-Free Fax: 1-844-303-1382  \nFax Inpatient Prior Authorization Requests:  \n• Fax Number: 214-266-2084  \n• Toll-Free Fax: 1-844-303-2807  \nEffective September 1, 2026, the following codes will be added to the PCHP Prior Authorization List 1  \n\n| Update | Code | Medical Service Category | Description | Effective Date |\n| --- | --- | --- | --- | --- |\n| ADD | J3405 | Medical Injectables | Injection, onasemnogene abeparvovec-brve (ITVISMA) | 9/1/2026 |\n| ADD | J7330 | Specialty Physician | Autologous cultured chondrocytes, implant | 9/1/2026 |\n| ADD | 27412 | Specialty Physician | Autologous chondrocyte implantation (ACI) in the knee | 9/1/2026 |\n\nEffective August 1, 2026, the following codes will be removed from the PCHP Prior Authorization List 1  \n\n| Update | Code | Medical Service Category | Description | Effective Date of Removal 2 |\n| --- | --- | --- | --- | --- |\n| REMOVED | J1412 | Medical Injectables | Injection, valoctocogene roxaparvovec-rvox (Roctavian) | 8/1/2026 |\n\n1 See supporting documentation (Appendix A)  \n2 Retro terminated by HHSC  \nAppendix A  \nPrior Authorization Submission Requirements for Medical Necessity  \nAll prior authorization requests should be submitted with supporting clinical documentation demonstrating medical necessity. This can include but is not limited to test results (labs, X-rays, scans, etc.), consultationsand progress notes, history and physicals, medication records, and inpatient and emergency room documentation along with the Texas Standard Prior Authorization Request Form for Health Care Services or designated form specific to the request.  \n[Forms can be accessed at](Forms can be accessed at Providers.ParklandHealthPlan.com/Resources/Forms)[ Providers.ParklandHealthPlan.com/Resources/Forms](Forms can be accessed at Providers.ParklandHealthPlan.com/Resources/Forms), the PCHP Provider Portal, and TMHP | Forms. Examples of forms include:  \n• Texas Standard Prior Authorization Request Form for Health Care Services  \n• Medicaid Physical, Occupational or Speech Therapy (PT, OT, ST) Prior Authorization Form  \n• Prior Authorization Request for Extension of Outpatient Therapy (TP2) Form  \n• Prior Authorization Request for Oxygen Therapy Devices and Supplies  \n• PDN Prior Authorization Forms  \n• DME Medical Supplies Order Form  \n• Non-Emergency Ambulance Prior Authorization Request  \n• Home Health Skilled Nursing Request and Plan of Care Form  \nUpon completing the designated form for services that are being requested, the provider should ensure that all essential information is included. The essential information required to initiate the prior authorization process, per UMCM 3.22:  \n• Member name  \n• Member number or Medicaid number  \n• Member date of birth  \n• Requesting provider name  \n• Requesting provider’s National Provider Identifier (NPI)  \n• Service requested: Current Procedural T","cbCaiuoeuCvecitc","https://ap.wps.com/l/cbCaiuoeuCvecitc","pdf",222905,"English","# PCHP Prior Authorization Requirement Update\n## Summary\n## Policy Updates and Reminder\n## Ways to Submit a Prior Authorization Request to PCHP\n## Codes Added to the PCHP Prior Authorization List\n## Codes Removed from the PCHP Prior Authorization List\n## Appendix A: Prior Authorization Submission Requirements for Medical Necessity\n## Essential Information to Initiate the Prior Authorization Process","[{\"question\":\"What does the PCHP prior authorization update notice mean for coverage decisions?\",\"answer\":\"The notice is for notification only and does not determine whether the benefit is covered by PCHP.\"},{\"question\":\"How is a prior authorization request submitted to PCHP?\",\"answer\":\"Requests can be submitted via the PCHP Provider Portal or by fax, including separate numbers for inpatient prior authorization requests.\"},{\"question\":\"What information is required to initiate the prior authorization process under UMCM 3.22?\",\"answer\":\"Essential items include member name, member number/Medicaid number, date of birth, requesting provider details (including NPI), requested service codes (CPT/HCPCS/CDT), requested start/end dates, and quantity of service units.\"},{\"question\":\"When must prior authorization requests include documentation for medical necessity?\",\"answer\":\"Prior authorization requests should include supporting clinical documentation demonstrating medical necessity, such as test results, consultations and progress notes, history and physicals, medication records, and inpatient/emergency room documentation.\"}]","Provider Network News - PCHP Prior Authorization Requirement Update | PDF",1789633840]