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December 2016 Texas Medicaid Provider Procedures Manual

Section 1: Provider Enrollment and Responsibilities : 1.1 Provider Enrollment and Reenrollment : 1.1.9 Required Enrollment Forms : Principal Information Form (PIF-2)
A PIF-2 must be completed by each principal/creditor, subcontractor, and creditor of the provider that is applying for enrollment with the following exceptions:
Principals of the provider include all of the following:
Any employee of the provider who exercises operational or managerial control over the entity or who directly or indirectly conducts the day-to-day operations of the entity
All individuals, companies, firms, corporations, employees, independent contractors, entities, or associations that have been expressly granted the authority to act for or on behalf of the provider
An individual or entity with a security interest in a debt that is owed by the provider if the creditor’s security interest is protected by at least 5 percent of property listed in Section III(c) of the Disclosure of Ownership
A subcontractor of the provider is defined as follows:
An individual, agency, or organization to which a disclosing entity has contracted or delegated some of its management functions or responsibilities of providing medical care to its patients; or
An individual, agency, or organization with which a fiscal agent has entered into a contract, agreement, purchase order, or lease (or leases of real property) to obtain space, supplies

Texas Medicaid & Healthcare Partnership
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