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1.2.2 Maintenance of Provider Information
Providers must, within 10 calendar days of occurrence, report in writing to TMHP Provider Enrollment changes in address (physical location or accounting), telephone number, name, ownership status, tax ID, and any other information pertaining to the structure of the provider's organization (for example, performing providers). Failure to notify TMHP of changes affects accurate processing and timely claims payment. Providers can update their address information using either the PIC Form on page B-82, or the Demographic Update (DU) Form on the TMHP website.
Providers should use the PIC Form to update physical or mailing addresses, telephone numbers, names, tax identification numbers (TIN), provider status, and other provider information on file with the Texas Medicaid Program and CSHCN Services Program.
The DU Form is only used to make changes to provider addresses on file with TMHP. Providers can use the DU Form on the TMHP website at any time via the My Account link. Providers must create a provider administrator account to access the DU Form on the secure pages of the TMHP website. Non administrator users must be assigned by the provider administrator. Only providers or their authorized representatives can access the provider administrator accounts to obtain and complete the DU Form. Providers will be prompted to verify their address(es) and make necessary changes at least once a year.
After the PIC or DU Form has been completed, it can be faxed to 1-512-514-4214, Attn: Provider Enrollment, or mailed to the address below for processing.
Texas Medicaid & Healthcare Partnership
Provider Enrollment
PO Box 200795
Austin, TX 78720-0795
Providers should keep a copy of the completed form for their records.
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