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2012 Texas Medicaid Provider Procedures Manual

Children’s Services Handbook : 4. Texas Health Steps (THSteps) Dental : 4.1 Enrollment

4.1 Enrollment
To become a provider of THSteps or intermediate care facility for persons with mental retardation (ICF-MR) dental services, a dentist must:
Currently be licensed with an active status by the Texas State Board of Dental Examiners (TSBDE) or currently be licensed in the state where the service was performed.
Practice within the scope of the provider’s professional licensure.
Complete the Dental Provider Enrollment Application and return it to TMHP.
Providers can download and print dental provider enrollment application forms from the TMHP website at or call the TMHP Contact Center at 1-800-925-9126 to request them.
All owners of a dental practice must maintain an active license status with the TSBDE to receive reimbursement from Texas Medicaid. Any change in ownership or licensure status for any enrolled dentist must be immediately reported in writing to TMHP Provider Enrollment and will affect reimbursement by Texas Medicaid.
A dental provider cannot be enrolled if his or her dental license is due to expire within 30 days; a current license must be submitted. Dental licensure for owners of a dental practice is a requirement of the Occupations Code, Vernon’s Texas Codes Annotated (VTCA), Subtitle D, Chapters 251-267 (the Texas Dental Practice Act).
A dentist must complete the Dental Provider Enrollment Application for each separate practice location and will receive a unique provider identifier for each practice location if the application is approved.
The application form includes a written agreement with HHSC.
Dental providers may enroll in the THSteps Dental program and ICF-MR Dental Programs or as a Doctor of Dentistry Practicing as a Limited Physician, or both. The enrollment requirements are different with respect to the category of enrollment.
Refer to:

Texas Medicaid & Healthcare Partnership
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