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 Provider Enrollment - Texas Medicaid - New Providers

What is Texas Medicaid?Click here if you are a current or former provider

Texas Medicaid is the state and federal cooperative venture that provides health-care benefits to eligible Texas residents. The Texas Health and Human Services Commission (HHSC) oversees Texas Medicaid and seeks to improve the health of Texas residents, both adults and children, who might otherwise go without health-care services.

For more information about HHSC, visit the website at www.hhsc.state.tx.us. You can also download the current Texas Medicaid Provider Procedures Manual for provider information and services covered under Texas Medicaid.

Why should I enroll in Texas Medicaid?

Texas Medicaid relies on its network of providers to render essential medical and preventive health-care services to Texas Medicaid clients.

As the front-line of service for Medicaid clients, this network of over 70,000 dedicated professionals make health care more accessible to more than 2.5 million Texas residents throughout the state.

The Texas Medicaid provider network enlists dedicated professionals to help meet the growing health-care needs of Medicaid clients.

How do I enroll in Texas Medicaid?

There are two ways providers may enroll:

  • To apply online, click here to activate your account. Follow the instructions for completing the online enrollment process. Download, print, and complete the application forms.
  • To submit a paper application, you will need to download the enrollment forms. You can access these forms by clicking the Forms button on a Medicaid Provider web page. The forms you need are under the Provider Enrollment section. You can also request an enrollment package from TMHP by phone at 1-800-925-9126 or by mail at:

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

How do I enroll in Texas Medicaid if I only want to order or refer services for Texas Medicaid clients?

Code of Federal Regulations (CFR) Title 42 §455.410(b) requires all ordering or referring physicians or other professionals who order or refer supplies and services under the Medicaid State plan, or under a waiver of the plan, to complete a shortened application form to enroll in Texas Medicaid for the limited purpose of ordering and referring services to Texas Medicaid clients. Individual providers who are not currently enrolled in Texas Medicaid and whose only relationship with Texas Medicaid is to order or refer supplies or services for Texas Medicaid-eligible clients must submit the abbreviated enrollment application to Texas Medicaid and receive a Texas Provider Identifier (TPI).

Ordering and referring providers do not submit claims to TMHP for rendered services. Although ordering and referring providers will not submit claims to Texas Medicaid, the ordering and referring provider’s National Provider Identifier (NPI) will be required on claims that are submitted by the providers that render the supplies or services.

The following summarizes the role of ordering/referring-only providers in Texas Medicaid:

  • Because ordering and referring providers do not bill Texas Medicaid for rendered services, they do not need to enroll in Medicaid as a billing provider. Ordering/referring-only providers need only to complete a short application designed for providers who order, refer, or prescribe services to Texas Medicaid clients.
  • Those enrolling for the limited purpose of ordering and referring will not be listed as Texas Medicaid providers in the Texas Medicaid provider directories.
  • Ordering/referring-only providers are not required to pay the application fee to complete the ordering/referring-only enrollment process.

Ordering- and Referring-Only providers must complete the following enrollment form to receive a TPI: Texas Medicaid Provider Enrollment Application Ordering and Referring Providers Only

For enrollment assistance contact the TMHP Contact Center at 1-800-925-9126, option 3, or the TMHP CSHCN Services Program Contact Center (1-800-568-2413) or click here to send an email to request assistance with enrollment questions.

 
   
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