resources Provider Newsletter ABOUT YOUR HEALTH is published as a service for members of the EL PASO HEALTH Provider network. EL PASO HEALTH Executive Offices are located at 1145 Westmoreland Drive, El Paso, TX 79925, 915-532-3778 or 1-877-532-3778, elpasohealth.com. Information in ABOUT YOUR HEALTH comes from a wide range of medical experts. If you have any concerns or questions about specific content in this newsletter, call 1-877-532-3778. Models may be used in photos and illustrations. Member Services 1-877-532-3778 EPHP11902510 - EPH-PR-Winter 2026 Provider Newsletter 2025 © Coffey Communications, Inc. All rights reserved. HEDIS is coming soon! The Healthcare Effectiveness Data and Information Set (HEDIS) is one of health care’s most-used performance improvement tools, and it is just around the corner. HEDIS season is scheduled to kick off in January 2026. This is your opportunity to make sure that your documentation highlights the care that you provide to our members. You will be receiving official medical records requests from EPH through our Provider portal. Medical record requests are sent out to our network Providers to obtain medical records for data that has not been captured in claims. Once you are ready, you can submit the medical records, and you will have four options to choose from: ■Secure fax ■Secure email ■Mail ■Pick-up Please consider using electronic data sharing, as this facilitates the process. Also, please submit requested records as soon as possible. Deadlines for medical record review come faster than you think! If you have any questions, please feel free to contact the Quality Improvement Department or Provider Relations Department at 915-532-3778. Telehealth the right way: What Providers need to know Telehealth is now a regular part of care for STAR and CHIP members. It saves time for patients and helps providers reach families where they are. To keep claims clean and avoid compliance issues, follow these key steps. Use secure systems Telehealth visits must use a secure, HIPAAcompliant platform. Apps like FaceTime or social media video calls do not meet Medicaid standards. Document consent Consent for telehealth must be recorded in the medical record. For children, parent or guardian consent is required before the visit. Capture details in the note A telehealth visit should be documented just like an in-person visit: history; medications; exam findings, when appropriate; plan; and follow-up. Always include the modality (video or phone). Use the right codes ■Place of service: Use the correct POS for the member’s location, such as POS 02 or POS 10. ■Modifiers: Use modifier 95 for most synchronous telehealth services. For audio-only visits, use modifier 93 or FQ, as appropriate. Avoid common pitfalls Recent reviews found errors such as: ■Wrong POS codes. ■Missing modifiers. ■No record of consent. These gaps increase audit risk and can lead to recoupments. By following TMPPM standards, providers can deliver safe care through telehealth while protecting Medicaid from fraud, waste, and abuse.
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