CSHCN 2008 > Provider Enrollment and Responsibilities > Provider Enrollment

3.1 Provider Enrollment

To enroll in the CSHCN Services Program, a provider of medical care or services must complete the required CSHCN Services Program Provider Enrollment Application and enter into a written Provider Agreement with the CSHCN Services Program. These forms are supplied by TMHP Provider Enrollment for providers submitting claims to TMHP. Forms are available for download from the TMHP website at www.tmhp.com, or providers may contact TMHP-CSHCN Services Program Provider Enrollment at 1-800-568-2413, which is available Monday through Friday, from 7 a.m. to 7 p.m., Central Time.

The enrollment application and other completed forms must be sent to TMHP Provider Enrollment at the following address:

Texas Medicaid & Healthcare Partnership
Attn: Provider Enrollment
PO Box 200795
Austin, TX 78720-0795

A CSHCN Services Program provider identifier is issued when TMHP determines that a provider qualifies for participation. The provider identifier is a unique number assigned to each provider.

A new enrollment application must be completed and a new provider identifier assigned when one of the following changes:

•Ownership-The new owner must take the following actions:

•Obtain recertification as a Title XVIII (Medicare) facility under the new ownership.

•Complete the CSHCN Services Program Provider Enrollment Application.

•Provide TMHP with a copy of the Contract of Sale (specifically, a signed agreement that includes the identification of previous and current owners in language that specifies who is liable for overpayments that were identified subsequent to the change of ownership, that includes dates of service before the change of ownership).

•Provide a listing of all of the provider identifiers affected by the change of ownership.

•Provider status (individual, group, performing provider, or facility)-Providers leaving group practices must send a signed letter on company letterhead to TMHP that states the date of termination. The letter should include the provider identifier, effective date of termination, and the group's provider identifier. The letter should be signed by an authorized representative of the group or the individual provider leaving the group. If the provider is joining a new group practice or enrolling as an individual, the provider must complete and submit a CSHCN Services Program Provider Enrollment Application to request enrollment in the new group or as an individual provider.

•Physical address-If the address is not within the Medicare locality and Medicare has issued a new Medicare number, the provider must complete and submit a CSHCN Services Program Provider Enrollment Application in order to enroll the new location.

•Provider type-Providers must submit a separate CSHCN Services Program Provider Enrollment Application for each provider type enrollment requested.

Potential new providers must follow all claims filing procedures while completing the enrollment process to be assigned a CSHCN Services Program provider identifier. This is particularly important when providing services to CSHCN Services Program clients before receiving a provider identifier.

TMHP must receive all claims for CSHCN services within the required filing deadlines, regardless of enrollment status. Claims filed while waiting to receive a provider identifier are denied; however, having met the claim filing deadline, a provider can resubmit or appeal the claims for payment after the CSHCN Services Program provider identifier is assigned. The resubmitted claim may be considered for payment if TMHP receives it within 120 days from the date of the denial.

When a provider renders services to a CSHCN Services Program client before receiving a provider identifier and has questions about this requirement or enrollment, the provider may call the TMHP-CSHCN Services Program Contact Center.

A provider cannot be enrolled if his or her license is due to expire within 30 days of the date of application. Evidence of current licensure must be submitted with the application.

All provider types must be enrolled with the Texas Medicaid Program as a prerequisite to enrolling in the CSHCN Services Program. Call the TMHP Medicaid Contact Center at 1-800-925-9126 for information about the Texas Medicaid Program enrollment requirements.

Descriptions of the required enrollment forms are provided in the following sections.

Exception: Funeral home providers. Refer to Chapter 31, "Transportation of Deceased Clients" for claims submission procedures.