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Reminder: Performing Providers That Receive Notification of No Claims Activity Have Six Months to Prevent TPI Termination

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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.

Reminder: TMHP terminates Texas Provider Identifiers (TPIs) that exceed 24 months with no claims activity. To avoid terminating TPIs that should remain active, TMHP sends a courtesy letter to all providers with TPIs that have been identified as having no claims activity over the previous 18 months.

It is possible for performing providers who treat Medicaid clients through a Medicaid managed care organization (MCO) to receive such a courtesy letter.

How Performing Providers Can Prevent Termination of Their TPI

Performing providers who treat Medicaid clients through an MCO but who still receive a courtesy letter about no claims activity should submit the following information to TMHP to prevent the termination of their TPIs:

A copy of the courtesy letter about no claims activity with a signed statement at the bottom of the letter that the performing provider does not wish to have their TPI terminated because they are continuing to treat Medicaid managed care clients along with the National Provider Identifiers (NPIs) of the entity for which they provide services.

Providers should send the above information to the following address:

Texas Medicaid & Healthcare Partnership

PO Box 202978

Austin, TX 78720-0978

TMHP must receive this information within six months from the date on the courtesy letter to prevent the TPI from being terminated.

Consequence of Not Submitting Required Information

If TMHP does not receive the above information, TMHP will terminate a TPI after 24 months without claim activity. TMHP will send the provider a termination letter and apply a payment denial code to the TPI. If a provider’s Medicaid TPI is terminated, any enrollments with any Medicaid MCOs or the Children with Special Health Care Needs (CSHCN) Services Program will also be terminated. Claims that are submitted for a terminated TPI after the payment denial code has been applied will be denied.

To have the payment denial code removed from a TPI, the provider must submit a completed application for the state health-care program in which they wish to enroll, and the application must be approved. The information on this application must match exactly the information currently on the provider’s file for the payment denial code to be removed.

Note: This information was originally published in an article titled, “Performing Providers That Receive Notification of No Claims Activity Have 6 Months to Prevent TPI Termination,” on December 27, 2013.

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