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2012 Texas Medicaid Provider Procedures Manual

Volume 1, General Information : Section 1: Provider Enrollment and Responsibilities : 1.5 Provider Responsibilities : 1.5.2 Maintenance of Provider Information : Online Provider Lookup (OPL)
The OPL is available on the public access portion of the TMHP website at Provider information can be viewed by providers, clients, and anyone who accesses the TMHP website.
Providers with certain provider types must verify and update key demographic information every six months in the Provider Information Management System (PIMS) to ensure their information is correct in the OPL. Affected provider types include, but are not limited to, physicians, nurses, dentists, and durable medical equipment providers.
If more than six months have elapsed since the required demographic information in the OPL was verified, access to the secure provider portal is blocked until the verification takes place. Upon logging into their accounts, users with administrative rights see a list of NPIs that require verification and update. After addressing each NPI listed on the page, administrative providers are able to proceed to their accounts.
If access to the secure portal has been blocked because of needed verification, nonadministrative users are not able to perform work functions on NPIs listed on the Review Required page. Nonadministrative users are advised to notify users with administrative rights so that they can verify demographic information and remove the block.
The My Account page has a link to the Provider Demographic Update web page. Current information will be displayed with a button to allow editable fields to be changed. Demographic information may be updated only by authorized administrators. This authorization is controlled through the Permissions Management link, also located on the My Account page. Fields that can be updated online include the following:
The following enhancements have also been made to the OPL to increase overall functionality:
Providers who make address updates may receive a confirmation e-mail from TMHP after the address has been verified and if their e-mail address has been provided.
Each provider specialty and subspecialty listed in the OPL now has a corresponding definition. Users can view the definitions by clicking "more information" on either the basic or advanced search page or by hovering over the specialty on the results page. The definitions have been added to help clients locate the correct type of provider.
Providers are able to self-declare as many as three subspecialties to identify the services they offer. Providers may declare only subspecialties that are within the scope of their practice. Users are able to search for a provider on the OPL using these subspecialties.
Clients using the OPL will use drop-down boxes to select search criteria. An initial list will display all providers that meet the specified search criteria. Clicking on any name in that list will display the provider’s specific information, including a map of the office location.
Links to health maintenance organization (HMO) websites are also provided, enabling clients to search each HMO’s network of participating providers. The OPL supports both English and Spanish language users, and search results can be printed.

Texas Medicaid & Healthcare Partnership
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