Important: You must be enrolled in Traditional Medicaid before enrolling in CSHCN or Texas Health Steps. Select "Add to an Existing Enrollment," then click "Apply Filters" if you would like instructions for adding CSHCN or Texas Health Steps to your existing enrollment.
Page Filters
These pages will guide you through each stage of the enrollment process using PEP. To customize this page's content, use the filters below and click the Apply Filters button.
Application Type:
Program(s):
Enrolling As:
W-9 Form
Instructions for Completing the Substitute W-9 Taxpayer Identification
Note: This page does not apply to Ordering and Referring Providers.
Note: This page does not apply to Performing Providers.
The Legal Name and Business Name field will be automatically populated with the name that you submitted on the Provider Demographics page.
Check the appropriate box for your federal tax classification.
If your federal tax classification is not one of the available options, select Other, and specify your classification in the space provided.
The Address field will be automatically populated with the address that you submitted in the Accounting/Billing Address field on the Provider Demographics page.
The Social Security number or Employer Tax Identification Number field will be automatically populated with the Employer’s TIN that you submitted on the Provider Demographics page.
Check the box to acknowledge “I attest this is what appears on my W-9.”
Click Continue and Save.
Contents
Go directly to a specific page's instructions by using the links below.
