Table of Contents Previous Next

December 2016 Texas Medicaid Provider Procedures Manual

Section 1: Provider Enrollment and Responsibilities : 1.1 Provider Enrollment and Reenrollment : 1.1.3 Paper Application Enrollment

As an alternative to applying for enrollment online, a provider may file a paper enrollment application with TMHP. Providers may download the Texas Medicaid Provider Enrollment Application at or request a paper application form by contacting TMHP directly at 1-800-925-9126. Enrollment applications are updated periodically. When an application has been updated, the older version will no longer be accepted and will not be available on the website. It is recommended that the provider check the website regularly for updates and notifications.
A paper enrollment application may also be requested from and must be submitted to the following address:
Texas Medicaid & Healthcare Partnership
Provider Enrollment
PO Box 200795
Austin, TX 78720‑0795

Texas Medicaid & Healthcare Partnership
CPT only copyright 2014 American Medical Association. All rights reserved.