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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 : Updating Provider Specialty
Providers that have made a change in their specialty must submit their updated specialty information to Texas Medicaid. The forms that must be submitted to Texas Medicaid depend on the provider’s enrollment, as follows:
Medicare-enrolled providers whose Medicare number has not changed must submit a copy of the Medicare letter listing the updated specialty along with a PIC Form to Texas Medicaid. Providers may submit the form by fax to TMHP (Attention Provider Enrollment) at 1-512-514-4214 or by mail to:
Texas Medicaid & Healthcare Partnership
Provider Enrollment
PO Box 200795
Austin, TX 78720-0795
Refer to:
Subsection 1.4, “Provider Reenrollment” in this section for more information about provider reenrollment in Texas Medicaid.

Texas Medicaid & Healthcare Partnership
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