CSHCN Services Program 2010 > Provider Enrollment and Responsibilities > Provider Enrollment

2.1 Provider Enrollment

Providers of medical services must be actively enrolled as a Texas Medicaid provider as a prerequisite to becoming a CSHCN Services Program provider. 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.

Refer to: Section 25.2, "Medical Foods".

Chapter 35, "Transportation of Deceased Clients".

Title 45 of the Code of Federal Regulations (CFR) Part 162.402 established the National Provider Identifier (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).

Providers are now required to document their National Provider Identifier (NPI) in the enrollment application. Providers that enrolled before May 23, 2008, must submit their NPI and related data to TMHP by completing the NPI attestation. Providers that have completed NPI attestation for Texas Medicaid must also complete NPI attestation for the CSHCN Services Program.

Refer to: The National Provider Identifier Special Bulletin, No. 202, for complete instructions on completing the online attestation. Provider attestation can be completed under the "I would like to..." section on the home page of the TMHP website at www.tmhp.com by selecting "Attest an NPI".

Group providers that complete the attestation for individual providers in their group must click the plus sign (+) to expand the list and reveal all of the performing providers in the group. Taxonomy codes should be selected for performing providers according to their specialty type.

Providers that have not completed NPI attestation will experience rejection or denial of claims.

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. 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. The provider identifier is a unique number assigned to each provider. 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 application.

The provider's enrollment effective date will be 6 months before the date the enrollment application is received 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.