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December 2016 Texas Medicaid Provider Procedures Manual

Section 1: Provider Enrollment and Responsibilities : 1.5 Change of Ownership Requirements

The new owner must do the following:
Provide TMHP with a copy of the Contract of Sale (specifically, a signed agreement that includes the identification of previous and current owners in language that specifies who is liable for overpayments that were identified subsequent to the change of ownership, that includes dates of service before the change of ownership)
When the change of ownership has been processed, the original TPI used by the provider to bill claims will be deactivated, and the provider will lose the ability to download R&S Reports from the TMHP portal as well as the ability to verify client eligibility online. Claims status inquiries through the TMHP portal will also be unavailable. After a TPI has been deactivated, the provider can call the contact center to check on client eligibility and the status of claims. Paper R&S Reports can be printed by the TMHP Contact Center, and delivered to providers, up to 30 days from the date the TPI is deactivated.
Providers must adhere to claim filing deadlines throughout the enrollment process. Claims should be submitted without a provider identifier until notified by TMHP of final enrollment determination. Note that claims for services that are rendered to Texas Medicaid clients are subject to a filing deadline from the date of service of 95 days for in-state providers and 365 days for out-of-state providers. For clients with retroactive eligibility, the 95-day deadline is based on the date of service or the date the client eligibility information is added to the TMHP eligibility file, whichever is later. For clients with dual Medicare and Medicaid eligibility, when a service is a benefit of both Medicare and Medicaid, the claim must be filed with Medicare first. In this case the 95-day deadline is based on the date of Medicare disposition.
Refer to:

Texas Medicaid & Healthcare Partnership
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