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Provider Enrollment on the Portal Instructions
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:

Revalidation Principal List

Instructions for Completing the Revalidation Principal List.

Note: This is a Revalidation page. If you would like information about another application type, Click Here.

This page does not apply to Ordering and Referring Providers.

This page does not apply to Performing Providers.

    Section B: Owners, Partners, Officers, Directors, and Principals

    You must identify the owners (sole proprietor or multiple owners), partners, officers, directors, and principals that you identified in the Principal Information Form (PIF-2). When identifying owners, you must include every individual who has 5% or more ownership in the entity, whether the ownership is direct or indirect.

    Medical Directors

    Ambulance providers are required to disclose the entity’s Medical Director, who must be a physician that is currently licensed by the Texas Medical Board. The medical director of an ambulance provider must complete the Principal Information Form (PIF-2).

    Authorized Representative

    The authorized representative is the person who will sign the HHSC Provider Agreement or any other provider agreement on behalf of a group or facility. The authorized representative must complete a PIF-2 form.

    Total Ownership

    The total of the ownership percentages of your entity must equal 100 percent. Non-profit 501(c)(3) entities do not have to have a total ownership percentage of 100 percent. If, for any reason, total ownership of an entity other than a 501(c) does not equal 100 percent, you must submit a brief explanation of the discrepancy.

    Fingerprinting

    All owners that have 5 percent or more direct or indirect ownership interest of a high-categorical risk provider may be required to submit proof of fingerprinting to enroll in or revalidate their enrollment in Texas Medicaid. You will not be able to complete the enrollment process until you submit copies of all of the required individuals’ fingerprinting receipts to TMHP.

    If you have already completed the fingerprinting process for Medicare enrollment, Texas Medicaid, or another state's Medicaid program, you can upload your proof of fingerprinting in the Electronic Attachments section or by mail to:

    Texas Medicaid and Healthcare Partnership

    ATTN: Provider Enrollment

    PO Box 200795

    Austin, TX 78720-0795

  1. Verify each person’s information by clicking PIF-2 under the “Link to PIF-2” column.
    1. If the person is no longer an owner or principal, you may click Delete to remove the PIF-2.
  2. Click Add another if you need to add Owners, Partners, Officers, Directors, and Principals who meet the definition of principal or subcontractor.
    1. To revisit a PIF-2, click PIF-2 to re-launch the form.
  3. Click Continue and Save.
 
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