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Provider Enrollment and Responsibilities
2.1 Provider Enrollment 2-2
2.1.1 Changes in Enrollment 2-3
2.1.2 Claim Filing 2-3
2.1.3 Provider Enrollment Determinations 2-4
2.1.4 Provider Enrollment Application 2-4
2.1.4.1 Types of Providers 2-4
2.1.4.2 Provider Information Form (PIF-1), Principal Information Form (PIF-2),
and Disclosure of Ownership Form 2-4
2.1.4.3 Provider Agreement 2-5
2.1.4.4 Request for Taxpayer Identification Number and Certification 2-5
2.1.4.5 Provider's License 2-5
2.1.5 Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) 2-6
2.1.6 Cleft/Craniofacial (C/C) Specialty Teams 2-6
2.1.6.1 Requirements for Cleft/Craniofacial (C/C) Team Enrollment 2-6
2.1.7 Transplant Specialty Centers 2-7
2.1.8 Out-of-State Providers 2-7
2.1.9 Substitute Physician 2-7
2.1.10 Providers of Family Support Services 2-7
2.2 Provider Complaints Process 2-8
2.3 Provider Responsibilities 2-8
2.3.1 Information Change Requests 2-9
2.3.2 General Medical Record Documentation Requirements 2-9
2.3.3 Retention of Records 2-10
2.3.4 Utilization Review: General Provisions 2-10
2.3.5 Release of Confidential Information 2-10
2.3.6 Waste, Abuse, and Fraud 2-11
2.3.7 Provider Certification/Assignment 2-11
2.3.8 Billing Clients 2-12
2.3.9 Texas Family Code Compliance 2-13
2.3.9.1 Child Support 2-13
2.3.9.2 Abuse and Neglect Reporting Requirements 2-13
2.3.10 Clinical Laboratory Improvement Amendments (CLIA) of 1988 2-13
2.4 TMHP-CSHCN Services Program Contact Center 2-13
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