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October 31, 2021 Enrollment and Credentialing Deadline for Non-LMHA Providers of Mental Health Targeted Case Management and Rehabilitative Services

Last updated on 8/25/2021

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.

For dates of service on or after November 1, 2021, non-local mental health authority (non-LMHA) providers of mental health targeted case management and mental health rehabilitative (MH TCM/MH Rehab) services must enroll and bill exclusively under the “MH Case Management/MH Rehabilitative Services—Non-LMHA” provider type.

The Texas Health and Human Services Commission (HHSC) continues to work with managed care organizations (MCOs) and providers to assist with the transition into the new provider type.

MH TCM/MH Rehab claims with dates of service on or before October 31, 2021 may be billed under existing provider types in managed care.

MH TCM/MH Rehab claims with dates of service on or after November 1, 2021 submitted under a provider type other than MH Case Management/MH Rehabilitative Services—Non-LMHA may be denied by MCOs.

Enrollment Steps

Non-LMHA providers of MH TCM/MH Rehab services who are currently enrolled in a provider type other than MH Case Management/MH Rehabilitative Services-Non-LMHA should begin the TMHP enrollment process found on the Provider Enrollment web page of tmhp.com. Non-LMHA providers seeking to enroll in Medicaid to provide MH TCM/MH Rehab services for the first time must use the same process. 

Providers must enroll as MH Case Management/MH Rehabilitative Services-Non-LMHA by selecting the facility option on the Provider Enrollment Portal (PEP) or completing the paper Enrollment Application for Facilities.

Non-LMHA providers are encouraged to enroll on the Provider Enrollment Portal (PEP).

Online enrollment has the following advantages for providers:

  • Applications are validated immediately to ensure that all fields are completed.
  • Most of the application can be completed online so that only a few forms need to be printed, completed, and mailed to TMHP.
  • Applicants can view both incomplete and completed applications submitted online.
  • Providers can complete the Provider Information Change form online through the Provider Information Management System (PIMS).

After receiving approval for enrollment in Texas Medicaid, the Non-LMHA provider must be contracted and credentialed by a Texas Medicaid MCO to provide services to Texas Medicaid eligible persons enrolled in Medicaid managed care.

Non-LMHA providers also must register online at HHSC’s Clinical Management for Behavioral Health Services page to use the Texas Department of State Health Services (DSHS) Clinical Management for Behavioral Health Services (CMBHS) clinical record-keeping system before providing services to Texas Medicaid eligible persons.

Providers that have already applied for and received access to the CMBHS system with their current National Provider Identifier (NPI), do not need to apply again under their new provider type.

Note: Both enrollment and credentialing must be completed no later than October 31, 2021.

Enrollment Details

Non-LMHA providers who are contracted for services outside of the array of MH TCM/MH Rehab services are not required to complete the enrollment and credentialing process above for services other than MH TCM/MH Rehab.

The new non-LMHA provider type is a “facility” entity designation. Since facilities have licensure or certification as an entity, individual performing and rendering providers do not need to be listed on enrollment applications. Providers will be subject to a facility fee, which will be applied to each location listed on the enrollment application.

Non-LMHA providers of MH TCM/MH Rehab services are not required to be Medicare-enrolled as a prerequisite for Medicaid enrollment.

Note: Providers enrolled under the new facility provider type will not be subject to facility-level review during the credentialing process.

Resources

For enrollment: Refer to the Texas Medicaid Provider Procedures Manual (TMPPM), Section 1: Provider Enrollment and Responsibilities, for additional information about provider enrollment or types of entities of which enrollment can be requested.

The Provider Enrollment Portal can be accessed at: www.tmhp.com/topics/provider-enrollment

For an online view of the enrollment application, go to: www.tmhp.com/sites/default/files/provider-forms/provider-enrollment/F00168_Enrollment_App_Facility_04152021.pdf

Contact the TMHP Contact Center at 800-925-9126 for enrollment assistance.

For credentialing and claims: Refer to Texas Administrative Code (TAC) Chapter 1 § 354.2601-2713 and 1 TAC § 353.1405 for a comprehensive list of services required by the TAC for MH TCM/Rehab benefits. Providers should contact the client's specific MCO for details.