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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 : Licensure Renewal
Not abiding by the license and certification update requirement may impact a provider’s qualification for continued participation in Texas Medicaid. If a provider’s license has expired, a deactivation letter will be sent to the provider, and all claims filed on and after the expiration date will be denied.
To have claims payments resumed, updated information must be sent to the applicable licensing board to renew the license. Payment will be considered for dates of service on or after the date of license renewal. Claims denied due to an inactive license may be appealed, and payment will be considered for dates of service on or after the date of return to active license status. Payment deadline rules for the fiscal agent arrangement must be met.
Refer to:
Subsection 6.1.5, “HHSC Payment Deadline” in Section 6, “Claims Filing” (Vol. 1, General Information).

Texas Medicaid & Healthcare Partnership
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