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News & Updates

October 31: Paper Claims Update
Please note the RightCare mailroom has currently moved to 300 S. Riverside Plaza Suite 700, Chicago, IL 60606. All mail sent to P.O. Box 3757 Corpus Christi, Texas 78463 will be forwarded to Chicago. Providers whose mail cannot be forwarded will have mail returned. For more information, please contact RightCare customer service at 855 897-4448 (855-TX-Right).
September 19: Retroactive APR DRG Relative Weight Change and 2019 Relative Weight Table
Background: HHSC has determined that an adjustment is needed for some All Patient Refined Diagnosis Related Group (APR DRG) relative weights and related factors. The relative weights that are being adjusted were for new APR DRGs in Grouper 35. The relative weights that were originally assigned were not proper for HHSCs reimbursement system.

Key Details: The changes will require an adjustment in payment to some inpatient claims and encounters with discharge dates on or after October 1, 2017. See below for links to the following information:
• Changes – a list of the impacted APR DRGs with revised and original details
• 2018 Revised Grouper Table – effective 10/1/2017
• 2019 Grouper Table – effective for discharges occurring on or after 9/1/2018
Note: There are no changes in the weight tables from 2018 to 2019. Any potential changes will be made effective 10/1/2018 when 3M release their APR DRG grouper updates.

September 7: Wraparound Training Webpage Update for MH TCM/Rehab Providers.
Wraparound training is a requirement for mental health (MH) targeted case management (TCM) providers to provide intensive targeted case management. In response to concerns brought by providers and health plans about accessing information on Wraparound training, HHSC is sharing that the Texas Center of the National Wraparound Implementation Center has updated its website to include more detailed information about the training .

August 28: Please visit HHSC’s new online resource for Prenatal Screening for Domestic Violence and Substance Use.

August 1: Anti-psychotics Clinic Prior Authorization Changes Begin September 1.
RightCare from Scott and White Health Plan will revise the anti-psychotics clinical prior authorization for people enrolled in Managed Medicaid beginning 9/1/18. To learn more please review the antipsychotics clinical prior authorization guide (PDF).

July 12: HHSC recently released an Op-Ed piece that features resources for women experiencing postpartum depression. This information was published in The Daily News and the Tyler Morning Telegraph.