|
1.1.3.12 Group Practices
A provider group participating in the Medicare Program that applies to be a Texas Medicaid group provider must complete a Texas Medicaid Provider Enrollment Application. Groups participating in Medicare must have a current Medicare number before enrolling with the Texas Medicaid Program. A valid and current Medicare number must be maintained. Performing providers of a Medicare group must also have a current Medicare number before enrolling in the Texas Medicaid Program. A current and valid Medicare number must be maintained. Providers must complete Section B of the application to enter the Medicare group provider number and Medicare performing provider numbers for each provider within the group.
Note: During the Texas Medicaid Program enrollment process, the Claims Administrator may waive the mandatory prerequisite for Medicare enrollment for certain providers whose type of practice is pediatric-based and who will never bill Medicare.
If additions or changes occur in the group's enrollment information (for example, a performing provider leaves or enters the group, changes an address, or a provider is no longer licensed) after the enrollment process is completed, the Medicare/Medicaid provider group must notify Medicare and the Texas Medicaid Program in writing within 10 calendar days of occurrence of the changes. Failure to provide this information may lead to administrative action by HHSC.
|
