This page is for current providers whose information has changed and former providers who want to re-apply to the program. If you have any questions about the enrollment process, you can call TMHP Provider Enrollment at 1-800-925-9126, Option 2.

Current Providers

When do I need to submit a new Texas Medicaid application?

You need to submit a new application whenever any of the following occur:

• New Medicare number
• Change of ownership
• Change of provider status (individual, group, performing provider, or facility), for example, a performing provider leaving a group practice
• Change or addition of a provider type
• Opening of additional practice locations

There has been a change of ownership. What do I need to do?

This document explains the steps you need to take when there has been a change in ownership.

What information can I change online or with a Provider Information Change form?

You can update the following information using a Provider Information Change form:

• Mailing address
• Physical address (as long as the new physical address did not result in a new Medicare number)
• Tax ID number

When do I need to submit a Principal Information Form?

Each principal for an existing provider must provide up-to-date information. If the information changes for a principal or a new principal is added, the principal needs to file a revised Principal Information Form (PIF-2), which is also part of the Texas Medicaid Enrollment Application.

All completed forms should be sent to the following address:

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

Former providers

I am not a current Medicaid provider but I used to be one. How do I re-apply?

Simply submit a new application with all of your current information.