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.
Beginning September 1, 2021, providers will no longer be required to use their Texas Provider Identifiers (TPIs) for submitting paper claims, paper prior authorization requests, or for calling TMHP. In addition, the TPIs will be removed from prior authorization forms, claim forms and instructions.
Providers Must use Their National Provider Identifiers (NPIs) Effective September 1, 2021
In place of the TPIs, providers must submit their NPIs on forms. Providers or individuals who do not provide health-care services and who are not required to have NPIs may have been issued Atypical Provider Identifiers (APIs) by Texas Health and Human Services (HHSC). These providers should use their APIs instead of the TPIs.
Providers Should Stop Using TPIs by December 9, 2021
To promote a smooth transition as the TPI is phased out, TMHP will continue to accept older forms that include TPIs after September 1, 2021, until December 8, 2021. After this transition period ends, only the revised NPI/API-based forms will be accepted.
For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.