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TPI Number Removed From Claim Forms, EDI Forms, and Instructions: Transition Period Ending November 30, 2021

Last updated on 11/12/2021

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.

Effective September 1, 2021, providers are no longer required to use their Texas Provider Identifiers (TPIs) for submitting paper claims and paper prior authorization requests or for calling TMHP. The TPI fields have been removed from claim forms, electronic data interchange (EDI) forms, and instructions.

Providers Must Use Their NPIs Effective September 1, 2021

In place of 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 are not required to have NPIs may have been issued Atypical Provider Identifiers (APIs). These providers should use their APIs instead of the TPIs.

Using the NPI will save time and simplify administrative work for health-care providers:

  • The NPI is a single provider identification number that will be recognized and accepted by all health plans.
  • Providers will no longer need to report, maintain, or track multiple provider identification numbers; this will improve the efficiency and effectiveness of electronic health-care transactions.

To promote a smooth transition as TPIs are phased out, TMHP will continue to accept older forms that include TPIs after September 1, 2021, until November 30, 2021. After this transition period ends, only the revised NPI/API-based forms will be accepted.

Providers Must Stop Using TPIs by December 1, 2021

Effective December 1, 2021, forms with TPIs will be returned, resulting in a delay in authorization approval or service reimbursement.

In place of TPIs, providers will need to submit their NPI/API, taxonomy code, benefit code (if applicable), and complete address with city, state, and ZIP+4 code. To avoid any claims processing errors, providers should complete their claims with the same information that was included on the prior authorization request.

The following forms and instructions have been revised and updated, and the forms will be available on September 1, 2021, as fillable PDFs on under “Forms” and on TMHP’s Prior Authorization on the Portal:

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