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1.1.4.13 Medicare Participation
Under federal law, Medicaid is the payor of last resort, so Medicare covered services must first be billed to and paid by Medicare. Therefore, in order to be eligible to enroll in Texas Medicaid, a provider must be a Medicare participating provider. Certain types of providers, however, are not required to meet the Medicare participation requirement, including the following:
• OB/GYN providers
•Pediatric providers
•Family Planning providers
•Comprehensive Care Program (CCP) providers
•Children and Pregnant Women (CPW) program providers
•Licensed professional counselors (LPCs)
•Licensed marriage and family therapists (LMFTs)
Each provider seeking enrollment must include a valid and current Medicare number in the Texas Medicaid Provider Enrollment Application, and must include with the application a copy of the provider's notice of Medicare participation.
Each group and each performing provider of a Medicare group must have a current Medicare number, and the group enrollment application must include the current and valid Medicare number for the group and for each performing provider in the group, as well as a copy of the notice of Medicare enrollment for the group and for each performing provider in the group.
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