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.
Coming Soon: Effective September 1, 2021, the Texas Provider Identifier (TPI) number will be removed from prior authorization forms and instructions, and claim forms that currently contain this identifier.
By state law, the Texas Health and Human Services Commission (HHSC) is now required to use the National Provider Identifier (NPI) instead of local identifiers, such as the TPI. Providers or individuals who do not provide health-care services and are not required to have an NPI, may have been issued an Atypical Provider Identifier (API) by HHSC. For those providers, HHSC will use the API instead of any other local identifiers.
While the TPI will be removed from the claim forms, there will be a transition period during which the previous forms will be accepted by TMHP to assist providers in transitioning to the NPI/API-based forms.
For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.