All providers must use the revised PIC Form beginning September 1, 2009. The form will change as follows:
-
One row of the Comments field has been deleted.
-
The field titled, “Patient age range accepted by provider:” has been expanded.
-
A new checkbox for “Hearing Services for Children” has been added to the field titled, “Additional services offered (check one):”
Providers who have established administrator accounts on this website may access the revised online PIC Form beginning September 1, 2009. The online PIC Form is available through the “Access Provider Enrollment” link on the TMHP website.
The revised paper PIC Form is available now for download from the TMHP Provider Enrollment web page. Providers may access the revised form by doing the following:
On this website’s home page, select Provider Enrollment Forms under the “Provider Forms” section.
-
On the Provider Enrollment web page, select Change some information.
-
To view the revised paper PIC form, providers may click here.
Hearing services providers: Enrolled hearing services providers who are experienced with the pediatric population and who will offer auditory services to Texas Medicaid or Children with Special Health Care Needs (CSHCN) Services Program clients who are birth through 20 years of age are encouraged to complete the online or paper PIC Form to designate themselves in the Online Provider Lookup (OPL) as “hearing services for children” providers. Effective September 1, 2009, providers who choose the “hearing services for children” designation will be found when clients, parents, and guardians search the OPL for these services.
Providers are not required to make this designation in order to submit claims for hearing services for children.
The following providers will automatically be assigned the designation in the OPL effective September 1, 2009:
· Program for the Amplification for Children of Texas (PACT) providers who are already enrolled with Texas Medicaid or the CSHCN Services Program.
· Hearing services providers who are newly enrolled and who indicate on the enrollment application that they will provide hearing services to Texas Medicaid or CSHCN Services Program clients who are birth through 20 years of age.
Hearing services providers must not submit the revised paper PIC form to TMHP to request the “hearing services for children” OPL designation before September 1, 2009. Providers who have established administrator accounts on the TMHP website may access the revised online PIC form beginning September 1, 2009.
Note: Effective for dates of service on or after September 1, 2009, hearing services are benefits for Texas Medicaid and CSHCN Services Program clients of any age. However, the “hearing services for children” OPL designation should only be requested by enrolled hearing services providers who are experienced with the pediatric population and who will offer auditory services to Texas Medicaid or CSHCN Services Program clients who are birth through 20 years of age.
For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.