TMPPM 2008 > Texas Medicaid Services > Dental > Provider Enrollment

19.2 Provider Enrollment

To become a provider of THSteps and/or ICF-MR dental services, a dentist must:

•Currently be licensed with an active status by the Texas State Board of Dental Examiners (TSBDE) or currently be licensed in the state where the service was performed.

•Practice within the scope of his professional licensure.

•Complete the Dental Provider Enrollment Application and return it to TMHP.

Providers can call the TMHP Contact Center at 1-800-925-9126 to request application forms, or down-load and print them from the TMHP website at www.tmhp.com. Out-of-state providers should refer to "Medicaid Service Provided Outside Texas" .

A dental provider cannot be enrolled if his or her dental license is due to expire within 30 days; a current license must be submitted. Dental licensure for owners of a dental practice is a requirement of the Occupations Code, Vernon's Texas Codes Annotated (VTCA), Subtitle D, Chapters 251-267 (the Dental Practice Act).

A dentist must complete the Dental Provider Enrollment Application for each separate practice location and will receive a unique provider identifier for each practice location if the application is approved.

The application form includes a written agreement with HHSC.

Dental licensure for owners of a dental practice is a requirement of the Dental Practice Act. All owners of a dental practice must maintain an active license status with the TSBDE to receive reimbursement from the Texas Medicaid Program. Any change in ownership or licensure status for any enrolled dentist must be immediately reported in writing to TMHP Provider Enrollment and will affect reimbursement by the Texas Medicaid Program.

Dental providers may enroll in the THSteps Dental and Intermediate Care Facility for the Mentally Retarded (ICF-MR) Dental Programs or as a Doctor of Dentistry Practicing as a Limited Physician, or both. The enrollment requirements are different with respect to the category of enrollment.

Dentists must specify a category of practice by choosing one of the specialties listed in "Categories of Practice" of this manual.

Important: All providers are required to read and comply with Section 1, Provider Enrollment and Responsibilities. In addition to required compliance with all requirements specific to the Texas Medicaid Program, it is a violation of Texas Medicaid Program rules when a provider fails to provide health-care services or items to Medicaid clients in accordance with accepted medical community standards and standards that govern occupations, as explained in 1 TAC §371.1617(a)(6)(A). Accordingly, in addition to being subject to sanctions for failure to comply with the requirements that are specific to the Texas Medicaid Program, providers can also be subject to Texas Medicaid Program sanctions for failure, at all times, to deliver health-care items and services to Medicaid clients in full accordance with all applicable licensure and certification requirements including, without limitation, those related to documentation and record maintenance.

Refer to: "Maintenance of Provider Information"

"Provider Enrollment" .