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2012 Texas Medicaid Provider Procedures Manual

Volume 1, General Information : Section 1: Provider Enrollment and Responsibilities : 1.1 Provider Enrollment : 1.1.5 Required Enrollment Forms : 1.1.5.9 Certificate of Formation or Certificate of Filing/Certificate of Incorporation

1.1.5.9
All providers that are legal entities must submit the Certificate of Formation or Certificate of Filing form. Obtain the form from the Office of the Secretary of State. The name on this form must exactly match the legal name shown on the W‑9 form. Out-of-state providers are exempt from submitting this form.
Texas corporations formed on or before December 31, 2005, must submit their Certificate of Incorporation.

Texas Medicaid & Healthcare Partnership
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