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1.3 Provider Reenrollment
Providers must submit a new application and a new provider identifier must be issued when there are changes in Medicare number, ownership, status, address, or principal information. The new application may be submitted electronically using PEP or by submitting a completed paper Texas Medicaid Provider Enrollment Application. A new application is required when one of the following changes:
• Medicare Number. If Medicare has issued a new Medicare number, the provider must complete and submit a Texas Medicaid Provider Enrollment Application in order to enroll the new location or with a new group.
•Change of Ownership. The new owner must do the following:
•Obtain recertification as a Title XVIII (Medicare) facility under the new ownership
•Provide TMHP with a copy of the Contract of Sale (specifically, a signed agreement that includes the identification of previous and current owners in language that specifies who is liable for overpayments that were identified subsequent to the change of ownership, that includes dates of service before the change of ownership)
•Provide a separate change of ownership and Texas Medicaid provider enrollment application for all of the provider identifiers affected by the change of ownership
•Submit any new enrollment application relating to a change in ownership to TMHP Provider Enrollment within 10 calendar days of the change
Important: Providers must adhere to claim filing deadlines throughout the enrollment process. Claims should be submitted without a provider identifier until notified by TMHP of final enrollment determination. Note that all claims for services rendered to Texas Medicaid clients who do not have Medicare benefits are subject to a filing deadline from the date of service of 95 days for in-state providers and 365 days for out-of-state providers.
Refer to: Subsection 6.1.3, "Claims Filing Deadlines" in Section 6, "Claims Filing" (Vol. 1, General Information).
•Provider Status (individual, group, performing provider, or facility). Providers leaving group practices must send a signed letter or a Provider Information Change Form to TMHP that states the date of termination. The letter should include the provider identifier, effective date of termination, and the group's provider identifier. The letter should be signed by an authorized representative of the group or the individual provider leaving the group. If the provider is joining a new group practice or enrolling as an individual, the provider must complete and submit a new Texas Medicaid Provider Enrollment Application to request enrollment in the new group or as an individual provider.
•Physical Address. If a provider has changed an address and the address is within the same Medicare locality, the provider must update the address information within 10 days. Updates may be made using the online provider lookup update screen located in the administrator section of TMHP's website at www.tmhp.com. Alternately, the provider may update the address information by completing and submitting a Provider Information Change Form. A W9 is required if the provider is changing the mailing address using a PIC form. If the address is not within the Medicare locality and Medicare has issued a new Medicare number, the provider must complete and submit a Texas Medicaid Provider Enrollment Application in order to enroll the new location. Dental providers must complete a TMHP Dental Provider Enrollment Application for each practice location.
•Change in Principal Information (as defined in subsection 1.1.5.3, "Provider and Principal Information Forms" in this section). This includes a change in corporate officers or directors, professional association membership, and managing employees. The change must be reported to TMHP within 10 calendar days of when it occurs.
Refer to: Subsection 1.4.2.2, "Online Provider Lookup" in this Section for additional information.
Providers must contact the Electronic Data Interchange (EDI) help desk directly and request an Electronic Remittance & Status (ER&S) Report each time a new provider identifier is issued to the provider. This form must be completed and returned to EDI with unique identifying information related to the new provider identifier to ensure there is no suspension in the provider's ability to access their ER&S statement on the TMHP Home Page at www.tmhp.com.
Providers must also contact any third-party EDI vendors with whom they are contracted to add any new provider identifiers to their ER&S Report. To obtain a portable data file (.pdf) copy of the ER&S Report on the TMHP Home Page, the provider must create an administrator account for each provider identifier belonging to them.
Providers that have been issued a new provider identifier through the TMHP enrollment or re-enrollment process must ensure that any prior authorizations affected have been updated to reflect the new provider identifier.
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