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Reminder: TPI Number to be Removed From Prior Authorization Forms, Claim Forms and Instructions, Effective September 1, 2021

Last updated on 8/16/2021

This article has been updated. For the updated information, click here.

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. 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 National Provider Identifiers (NPIs) and related data 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). 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 from September 1, 2021, until December 8, 2021. After this transition period ends, only the revised NPI/API-based forms will be accepted.

Important: Beginning December 9, 2021, forms with TPIs will be returned, resulting in a delay in authorization approval or service reimbursement.

Automated Inquiry System (AIS)

Because the TPI will no longer be required for inquiries through Interactive Voice Response, the Automated Inquiry System (AIS) is being updated to support NPI/API-based requests effective September 1, 2021.

The changes are as follows:

  • AIS will no longer prompt for a TPI.
  • AIS will no longer support provider inquiries for benefit limitations, check amount, or medically needy.
  • AIS will direct providers to other online venues (TexMedConnect; provider inquiry line) for the functions that are no longer supported. 

For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.