TMPPM 2008 > Provider Information > Provider Enrollment and Responsibilities > Provider Enrollment

1.1.3.1 Texas Medicaid Provider Enrollment Application

The Texas Medicaid Provider Enrollment Application must be submitted by all providers who want to enroll in the Texas Medicaid Program, and it must be signed by the person who is applying for enrollment. If the applicant is an entity, a Principal of the entity must sign the application. "Principal" is defined in "Provider and Principal Information Forms" . If the provider is enrolled in Medicare, the provider must submit a copy of the Medicare Confirmation Letter. Applications must be complete in order to process and issue a provider identifier.

Refer to: "Provider and Principal Information Forms" for a definition of Principal.

Providers can call the TMHP Contact Center at 1-800-925-9126, Option 2, for help with completing the application. Providers should retain a copy of the original application for future reference.

Providers will be notified of incomplete applications and will have 30 business days to provide the requested missing information. If the information is not provided within 30 business days, TMHP will terminate the enrollment process and a new enrollment application must be submitted. Providers are required to review their enrollment application for correctness and completeness before submitting it to TMHP.