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Updated Enrollment Applications Now Available

Last updated on 4/26/2021

The following Texas Medicaid provider enrollment applications and application instructions have been updated:

  • Enrollment Application for Facilities
  • Enrollment Application for Groups
  • Enrollment Application for Individuals
  • Enrollment Application for Performing Providers

The updated applications will include the “Healthy Texas Women (HTW) Certification required for reimbursement” legend symbol for provider types that are required to complete an HTW certification to receive reimbursement for HTW services. The updated applications and instructions can be found on the TMHP Forms web page in the Provider Enrollment – Applications section, and Provider Enrollment on the Portal (PEP).

Note: For paper applications submitted to TMHP, the TMHP Provider Enrollment Department will accept previous versions of the above referenced applications through May 15, 2021. As of May 16, 2021, TMHP will only accept the revised versions of the applications posted on this website. Previous versions of the applications, submitted on or after May 16, 2021, will be marked as deficient and returned to the provider with a request that the correct version of the application be submitted with all required documentation.

For more information, call the TMHP Contact Center at 800-925-9126.