TMPPM 2008 > Texas Medicaid Services > Physician > Enrollment

36.1 Enrollment

36.1.1 Physicians and Doctors

To enroll in the Texas Medicaid Program to provide medical services, physicians (doctor of medicine [MD] and doctor of osteopathy [DO]) and doctors (doctor of dental medicine [DMD], doctor of dental surgery [DDS], doctor of optometry [OD], doctor of podiatric medicine [DPM], and doctor of chiropractic medicine [DC]) must be authorized by the licensing authority of their profession to practice in the state where the services are performed at the time they are provided.

Providers cannot be enrolled in the Texas Medicaid Program if their licenses are due to expire within 30 days. A current Texas license must be submitted.

Important: Centers for Medicare & Medicaid Services (CMS) guidelines mandate that physicians who provide durable medical equipment (DME) products such as spacers or nebulizers are required to enroll as Texas Medicaid Program DME providers.

All physicians except gynecologists, pediatricians, pediatric sub-specialists, pediatric psychiatrists, and providers performing only Texas Health Steps (THSteps) medical or dental check ups must be enrolled in Medicare before Medicaid enrollment. TMHP may waive the Medicare enrollment prerequisite for pediatricians or physicians whose type of practice and service may never be billed to Medicare.

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 Title 1 Texas Administrative Code (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: "Provider Enrollment" for more information.