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December 2016 Texas Medicaid Provider Procedures Manual

Section 1: Provider Enrollment and Responsibilities : 1.6 Provider Responsibilities : 1.6.2 Maintenance of Provider Information

Within 10 calendar days of occurrence, providers must report changes in address (physical location or accounting), telephone number, name, federal tax ID, and any other information that pertains to the structure of the provider’s organization (for example, performing providers). Changes in address, office telephone or fax number, and email address should be updated online using the OPL update page. Alternately, providers may update their address information using the PIC Form referenced below on the TMHP website. A W9 is required if the provider is changing the mailing address. A copy of the Medicare approval letter listing the additional location or site must be submitted when adding alternate physical addresses.
Refer to:
Provider Information Change Form on the TMHP website at
If the physical address is not within the same Medicare locality and Medicare has issued a new Medicare number, the provider must complete and submit a Texas Medicaid Provider Enrollment Application in order to enroll the new location.
Refer to:
Providers are notified when they have an invalid address on file with TMHP. Account administrators who log onto their accounts through the TMHP website at are notified when they have an invalid address on file for any of the TPIs associated with their NPI.
The Check Status Amount Search screen on the provider’s secure homepage of the TMHP website will alert providers when payments are pending because of inaccurate or incomplete provider information. R&S Reports that are viewed on the TMHP website also notify the provider of pending payments.
Pending payments are released in the financial cycle of the following week after the address information has been updated. Payments that are pending for more than 180 days will be voided.
Other changes (in name, ownership status, federal tax ID, etc.) must be reported in writing to TMHP Provider Enrollment. Failure to notify TMHP of changes affects accurate processing and timely claims payment. In addition, failure to timely report such changes is a violation of the rules of Medicaid, and may result in administrative, civil, or criminal liability.
Refer to:
Providers will be prompted to verify their address(es) and make necessary changes at least once a year.
After the PIC form has been completed, it can be faxed to 1-512-514-4214, Attn: Provider Enrollment, or mailed to the address below for processing.
Texas Medicaid & Healthcare Partnership
Provider Enrollment
PO Box 200795
Austin, TX 78720-0795
Providers should keep a copy of the completed form for their records.

Texas Medicaid & Healthcare Partnership
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