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Group-Initiated Performing Provider Revalidations

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Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to Medicaid members who are enrolled in their MCO. Administrative procedures, such as prior authorization, precertification, referrals, and claims and encounter data filing, may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the member’s specific MCO for details.

Group-initiated performing provider revalidations requesting an informal desk review will now include contact fields to capture the enrolling performing providers’ contact information.

Texas Health and Human Services Commission (HHSC) provider agreements for group-initiated performing provider revalidation requests will now also include the full Provider Enrollment and Management System (PEMS) request information as listed on the application at the time the agreement was sent to be electronically signed. Providers are responsible for reviewing and verifying that all information is correct. After the information has been verified, the HHSC agreement must be signed near the bottom of the document.

For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.