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2012 Texas Medicaid Provider Procedures Manual

Volume 1, General Information : Section 1: Provider Enrollment and Responsibilities : 1.1 Provider Enrollment : 1.1.3 Provider Enrollment Application Determinations : 1.1.3.1 Provider Identifiers Deactivated After 24 Months of No Claim Activity

1.1.3.1
Payment denial codes are applied to a Texas Provider Identifier (TPI) that has had no claim activity for a period of 24 months or more. The TPI will be considered inactive and will not be able to be used to submit claims.
A courtesy letter will be sent to all providers whose TPIs have been identified as not having any claims activity over the previous 18 months. Providers will have six months to submit claims and prevent the TPI from being deactivated. If the provider is enrolled in both Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program, the provider identifiers for both programs will be examined to determine whether claims activity has occurred.
After 24 months without claim activity, providers will be sent a deactivation letter, and a payment denial code will be applied to their provider identifier. If a provider’s Medicaid TPI is deactivated, any enrollments associated with the inactive TPI with the CSHCN Services Program will also be deactivated. Claims that are submitted for a deactivated TPI after the payment denial code has been applied will be denied.
To have the payment denial code removed from a provider identifier, providers must submit a completed application for the state health-care program in which they wish to enroll, and the application must be approved. The information on this application must match exactly the information currently on the provider’s file for the payment denial code to be removed.
Providers that file claims only for managed care organizations (MCOs) directly to the health plans rather than to TMHP must request to be exempted from the 24-month claim activity requirement. If these providers do not request to be exempted, their provider identifiers will be deactivated after 24 months of inactivity.

Texas Medicaid & Healthcare Partnership
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