TMPPM 2008 > Appendices > Women's Health Program > Provider Enrollment

O.2 Provider Enrollment

Providers who may bill family planning services under the WHP include: physician, NP, CNS, PA, certified nurse-midwives (CNMs), federally qualified health center (FQHC), or family planning agency.

To be considered for reimbursement, providers who render noninstitutional professional services billed on a CMS-1500 or Family Planning (FP) 2017 claim to WHP clients must be enrolled in the Texas Medicaid Program as professional service providers. HHSC limits referrals of WHP clients for primary care only to providers who do not perform or promote elective abortions, or do not contract or affiliate with entities that perform or promote elective abortions.

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 about enrollment procedures.

"Title XIX Enrollment" .