Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, pre-certification, referrals, and claims/encounter data filing may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the client's specific MCO for details.
Beginning March 1, 2020, TMHP will update the Texas Medicaid Provider Procedures Manual, Vol. 1, General Information, Provider Enrollment and Responsibilities, subsection 18.104.22.168 “Copy of License and Temporary License or Certification” to add an automated system for handling provider licensure information to cover certified registered nurse anesthetist, nurse practitioner, ophthalmologist, and physical therapy providers.
If an update has not been made in the last 60 days before the provider’s license expiration date, a reminder letter is automatically generated and sent to the provider with instructions to contact the licensing board regarding the renewal of the license. When the license is renewed, the provider will not need to contact TMHP with renewal information.
If a provider's license is expired, suspended, revoked, or inactive, a disenrollment letter will be sent to the provider, and all claims filed on and after the expiration date will be denied.
For more information, call the TMHP Contact Center at 800-925-9126.