CSHCN 2009 > Provider Enrollment and Responsibilities > Provider Enrollment

2.1 Provider Enrollment

Providers of medical services must be currently enrolled as a Texas Medicaid provider as a prerequisite to becoming a CSHCN Services Program provider. This requirement is waived for providers of certain program services such as family support providers and medical foods. For information about Texas Medicaid enrollment requirements, or to complete an online enrollment, visit the TMHP website at www.tmhp.com. Providers can call the TMHP Contact Center at 1-800-925-9126 for additional information, or for help with completing the application.

Refer to: Section 5.1.2, "Claims Processed by the Department of State Health Services (DSHS)-CSHCN Services Program".

Section 24.2, "Medical Foods".

Chapter 34, "Transportation of Deceased Clients".

The National Provider Identifier (NPI) final rule, Federal Register 45, Code of Federal Regulations (CFR) Part 162, established the NPI as the standard unique identifier for health-care providers and requires covered health-care providers, clearinghouses, and health plans to use this identifier in Health Insurance Portability and Accountability Act (HIPAA)-covered transactions. An NPI is a 10-digit number assigned randomly by the National Plan and Provider Enumeration System (NPPES). An NPI number is required on all enrollment applications.

TMHP verifies NPIs with NPPES to ensure that the NPI is active. If the NPI is shown by NPPES to be inactive, TMHP will notify the provider by letter. The provider will be allowed a 60-day grace period to contact NPPES and resolve their NPI status. If the inactive NPI has not been reinstated within the 60-day grace period, TMHP will disenroll all TPIs associated with the inactive NPI.

To enroll in the CSHCN Services Program, a provider of medical care or services must complete the required CSHCN Services Program Provider Enrollment Application and enter into a written Provider Agreement with the CSHCN Services Program. These forms are supplied by TMHP Provider Enrollment for providers submitting claims to TMHP. Forms are available for download from the TMHP website at www.tmhp.com.

Providers may also enroll in the CSHCN Services Program online. A link to the provider enrollment application is provided on the TMHP website homepage at www.tmhp.com and on the CSHCN Services Program website at www.dshs.state.tx.us/cshcn/providers/.

Online enrollment has the following advantages:

•Applications are validated immediately to ensure that all fields have been completed.

•Most of the application can be completed online so that only a few forms need to be printed, completed, and mailed to TMHP. Forms that must be mailed are identified in the online application.

•Applicants can view incomplete and complete applications that have been submitted online.

•Some form fields are automatically completed, reducing the amount of information that has to be entered.

•Providers can complete the Provider Information Change (PIC) form online.

•Providers will receive e-mail notifications when messages or deficiency notices about their applications are posted online. Providers may opt out of e-mail communication and receive messages or deficiency letters by mail.

If not completed online, the enrollment application and other completed forms must be sent to TMHP Provider Enrollment at the following address:

Texas Medicaid & Healthcare Partnership
Attn: Provider Enrollment
PO Box 200795
Austin, TX 78720-0795
Fax: 1-512-514-4214

For assistance with the application process or to obtain enrollment forms, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413, which is available Monday through Friday, from 7 a.m. to 7 p.m., Central Time.

A CSHCN Services Program provider identifier is issued when all required forms and documentation have been received and the application process is completed. A provider cannot be enrolled if his or her license is due to expire within 30 days of the date of application. TMHP verifies license information provided with the enrollment. The provider identifier is a unique number assigned to each provider.

The provider's enrollment effective date will be 6 months before the date the enrollment application is received for all providers or the traditional Medicaid enrollment effective date, whichever is more current.

Exception: For dentists who are also requesting enrollment in a cleft/craniofacial team, the effective date is the approval date of the CSHCN Services Program Enrollment Approval Form.