There are three basic parts to submitting an application:
- Determine your application type
- Submitting the application
- Complete the process
Learn more about each part below.
Your application type will determine how Texas Medicaid & Healthcare Partnership (TMHP) will process your application. Depending on your selection you may receive a new Texas Provider Identifier (TPI).
A new enrollment is when a provider submits an enrollment application for one of the following reasons:
- New provider (i.e., individual, performing, group, or facility)
- New practice location, when applicable
- Change of ownership
- New provider type and/or specialty
- New or additional state health-care program
A re-enrollment is when a provider submits an enrollment application after being disenrolled, terminated, excluded or otherwise removed as a provider; meaning the provider’s or supplier’s billing privileges are terminated. The provider will receive the same risk category assignment and go through the same provider screening activities as a newly enrolling provider.
For example, providers would have to re-enroll if they:
- Were disenrolled because they had no claim activity for 24 months
- Were previously excluded or terminated from Medicare or any state Medicaid or the Children’s Health Insurance Program
- Did not submit a revalidation application that was received before the end of their enrollment period
The ACA requires providers to submit a revalidation application at the end of their enrollment period. Most providers have an enrollment period of five years. Some providers have shorter enrollment periods (e.g., 1 year, 2 years). Providers can find the effective dates of their enrollment period within PIMS and on their Provider Welcome letter.
Providers should submit their revalidation applications at least 90 days before the end of their enrollment period so that it can be processed before the enrollment period ends. If a provider does not complete the revalidation process before the end of the provider's enrollment period, there will be a gap in the provider’s Medicaid enrollment.
- If the provider’s enrollment period ends before the provider completes the revalidation process, the provider will not be reimbursed for services rendered from the day after the enrollment period ends until the day on which the provider successfully completes the revalidation process. The provider is responsible for appealing any claims that were denied during that period of time.
- If a provider’s enrollment period ends before the provider’s revalidation application has been received, the provider is automatically disenrolled the day after the enrollment period ends. The provider must then submit a new enrollment application and forfeits the ability to utilize the streamlined revalidation application process. The provider will not be reimbursed for services that are rendered from the day after the enrollment period ends until the day on which the provider successfully completes the re-enrollment process.
Provider Enrollment on the Portal (PEP) is the fastest and easiest way to complete the provider enrollment application. PEP also makes it easier for existing providers to maintain their account information.
The PEP process uses less paper: Most of the information on the application can be submitted using PEP.
There is less opportunity for error: The information entered in PEP can be checked and validated before submission.
PEP provides immediate feedback on your application status: Providers can track the status of the application online and sign up to have deficiency notifications sent by email. This gives providers almost instant notice of any issues with their applications.
For a step by step guide to Provider Enrollment on the Portal, visit the PEP Instructional Site.
Providers that are not able to print the enrollment forms and those who do not wish to enroll online can request an enrollment package from TMHP by calling 800-925-9126 or by mailing a request to:
Texas Medicaid & Healthcare Partnership
ATTN: Provider Enrollment
PO Box 200795
Austin, TX 78720-0795
TMHP is committed to assisting providers with enrollment in the Texas Medicaid program and other State Health-Care programs. Computer Based Training (CBT) and other resources to assist with this process are available in the Enrollment Help section of this site. You may also find the following guides and FAQs useful for preparing and completing the enrollment process with TMHP:
How to prepare for the enrollment process:
- Provider Enrollment Tools Quick Reference Guide
- Provider Enrollment Electronic Signature Instructions
How to complete the enrollment process:
Once an application has been submitted, it will be reviewed by a Provider Enrollment Specialist. If any deficiencies are identified within the application, Provider Enrollment will request the required corrections.
After the application has been determined to be free of all deficiencies, it may require additional review, such as a site visit or an approval from HHSC.
Once all required approvals have been obtained, the application will be finalized and you will receive a notification letter confirming the completion of the application; it will and notify you of your next revalidation date.
If any of your information changes before your revalidation date, you must update your enrollment record by submitting a File Maintenance request through Provider Information Management System (PIMS) or through a Provider Information Change form.
Important: You must complete the revalidation process by the deadline. If you don’t complete the revalidation process by the deadline, you will be disenrolled from all Texas health care programs and your claims and prior authorization requests will be denied. You must submit a re-enrollment application, and you won’t be able to submit claims or prior authorization requests during the re-enrollment process.