Chapter 2 of the
CSHCN Services Program Provider Manual
includes details of the enrollment process.
Providers are encouraged to use Provider Enrollment on the Portal, which
completes the enrollment process electronically. Click here for:
The Paper Enrollment Process
Provider who prefer to submit a paper enrollment application must
follow this process. For assistance with the application process, call the
TMHP-CSHCN Services Program Contact
Center at 1-800-568-2413, Option 2. Retain a copy of
the original application for future reference.
After completing the enrollment application providers should send it and the
supporting documentation to the following address:
Texas Medicaid & Healthcare Partnership
PO Box 200795
Austin, TX 78720-0795
Applicants will be notified of incomplete applications and will have 30
business days to provide the requested missing information. If the information
is not provided within 30 business days, TMHP will terminate the enrollment
process and a new enrollment application must be submitted. To prevent
unnecessary delays in the enrollment process, applicants should thoroughly
review their enrollment application for accuracy and completeness before
submitting it to TMHP.
Who must complete a new enrollment form?
Providers wanting to participate in the CSHCN Services
Program must complete an enrollment application. Providers of medical services
must be actively enrolled as a Texas Medicaid provider as a prerequisite to
becoming a CSHCN Services Program provider. This requirement is waived for
providers of non-medical program services such as family support providers,
funeral homes, meals, lodging, or transportation providers.
A new CSHCN Services Program Provider Enrollment Application
must be completed whenever a provider is required to reapply to the Texas
Medicaid Program because of a change to the following:
- Medicare number
- Provider status (individual, group, performing provider, or facility)
- Provider type
Required Paper Enrollment Forms
Providers who are submitting a paper enrollment application to the CSHCN
Services Program must complete the following forms: