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Provider Enrollment and Responsibilities
1.1 Provider Enrollment 1-2
1.1.1 TMHP Provider Enrollment 1-2
1.1.2 Enrollment in Medicaid Managed Care Programs 1-3
1.1.3 Required Enrollment Forms 1-3
1.1.3.1 Texas Medicaid Provider Enrollment Application 1-3
1.1.3.2 HHSC Medicaid Provider Agreement 1-3
1.1.3.3 Provider and Principal Information Forms 1-3
1.1.3.4 Disclosure of Ownership and Control Interest Statement 1-4
1.1.3.5 Internal Revenue Service (IRS) W-9 Form 1-4
1.1.3.6 Medicaid Audit Information Form 1-4
1.1.3.7 Corporate Board of Directors Resolution 1-4
1.1.3.8 Certificate of Good Standing (Board
Corporation Act, Article 2.45) 1-4
1.1.3.9 Certificate of Formation or Certificate of Filing 1-4
1.1.3.10 Certificate of Authority 1-4
1.1.3.11 Copy of License/Temporary License/Certification 1-4
1.1.3.12 Group Practices 1-5
1.2 Provider Responsibilities 1-5
1.2.1 Compliance with Texas Family Code 1-5
1.2.1.1 Child Support 1-5
1.2.1.2 Reporting Child Abuse or Neglect 1-5
1.2.1.3 Procedures for Reporting Abuse or Neglect 1-5
1.2.1.4 Procedures for Reporting Suspected Sexual Abuse 1-6
1.2.2 Maintenance of Provider Information 1-6
1.2.2.1 Online Provider Lookup 1-7
1.2.3 Retention of Records and Access to Records and Premises 1-7
1.2.4 Release of Confidential Information 1-8
1.2.5 Compliance with Federal Legislation 1-8
1.2.6 Utilization Control - General Provisions 1-9
1.2.7 Provider Certification/Assignment 1-9
1.2.7.1 Delegation of Signature Authority 1-10
1.2.8 Billing Clients 1-10
1.2.8.1 Client Acknowledgment Statement 1-11
1.2.9 General Medical Record
Documentation Requirements 1-11
1.2.10 Stale-Date Check Process 1-12
1.2.11 Informing Pregnant Clients About CHIP Benefits 1-12
1.3 Medicare/Medicaid Waste, Abuse, and Fraud Policy 1-13
1.3.1 Reporting Waste, Abuse, and Fraud 1-18
1.3.2 Suspected Cases of Provider Waste, Abuse, and Fraud 1-19
1.3.3 Employee Education on False Claims Recovery 1-19
1.4 Texas Medicaid Program Limitations and Exclusions 1-19
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