Provider Enrollment Texas Health Steps Medical Page

Texas Health Steps Medical (THSteps) is Medicaid’s comprehensive preventive child health service for individuals from birth through 20 years of age. THSteps includes periodic medical, vision, hearing, and dental screenings. For more detailed information, access the program’s web pages on the Department of State Health Services (DSHS) website.

Providers that are enrolled with the Texas Medicaid Program can apply to provide services to the Texas Health Steps (THSteps) Program by completing the following forms:

THSteps Provider Enrollment Application	All providers.
Provider Information Form (PIF-1)	All providers applying for THSteps enrollment more than one year from their Texas Medicaid enrollment date.
Principal Information Form (PIF-2)	Each principal of all providers applying for THSteps enrollment more than one year from their Texas Medicaid enrollment date.
Disclosure of Ownership Form	All providers applying for THSteps enrollment more than one year from their Texas Medicaid enrollment date.
W-9 Request for Taxpayer Identification Number and Certification	All providers.
EFT Agreement	Electronic Funds Transfer

All completed forms should be sent to the following address:

Texas Medicaid & Healthcare Partnership
ATTN: Provider Enrollment
PO Box 200795
Austin, TX 78720-0795

If you have any questions about the enrollment process, call TMHP Provider Enrollment at 1-800-925-9126, Option 2.

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Provider Enrollment - Texas Health Steps - Medical