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 Children with Special Health Care Needs (CSHCN) Services Program authorization forms, prior authorization forms, miscellaneous forms, and form 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.
The following forms and instructions have been revised and updated, and the forms will be available on September 1, 2021, as fillable PDFs on tmhp.com under “Forms,” and on TMHP’s Prior Authorization on the Portal:
- F00004: CSHCN Services Program Authorization and Prior Authorization Request
- F00005: CSHCN Services Program Authorization and Prior Authorization Request for Hemophilia Blood Factor Products
- F00008: CSHCN Services Program Prior Authorization Request for Extension of Outpatient Therapy (TP2) Form
- F00009: CSHCN Services Program Prior Authorization Request for Initial Outpatient Therapy (TP1)
- F00010: CSHCN Services Program Prior Authorization Request for Non-Face-to-Face Clinician-Directed Care Coordination Services
- F00016: CSHCN Services Program Criteria for Dental Therapy Under General Anesthesia
- F00027: CSHCN Services Program Home Health Skilled Nursing Request and Plan of Care Form and Instructions
- F00033: Home Telemonitoring Services Prior Authorization Request
- F00050: CSHCN Services Program Prior Authorization Request for Durable Medical Equipment (DME)
- F00052: CSHCN Services Program Prior Authorization Request for Augmentative Communication Devices (ACDs) Form
- F00054: CSHCN Services Program Prior Authorization Request for Dental or Orthodontia Services
- F00055: CSHCN Services Program Prior Authorization Request for Diapers, Pull-ups, Briefs, and Liners
- F00056: CSHCN Services Program Prior Authorization Request for Diabetic Equipment and Supplies Form
- F00057: CSHCN Services Program Prior Authorization Request for Hospice Services
- F00058: CSHCN Services Program Prior Authorization Request for Inpatient Hospital Admission
- F00059: CSHCN Services Program Prior Authorization Request for Inpatient Psychiatric Care
- F00060: CSHCN Services Program Prior Authorization Request for Inpatient Rehabilitation Admission
- F00061: CSHCN Services Program Prior Authorization Request for Inpatient Surgery – For Surgeons Only
- F00062: CSHCN Services Program Prior Authorization Request for Medical Foods
- F00063: CSHCN Services Program Prior Authorization Request for Medical Nutritional Services
- F00065: CSHCN Services Program Prior Authorization and Authorization Request for Outpatient Surgery – For Outpatient Facilities and Surgeons
- F00067: CSHCN Services Program Prior Authorization Request for Renal Dialysis Treatment
- F00068: CSHCN Services Program Prior Authorization Request for Respiratory Care – Certified Respiratory Care
- F00069: CSHCN Services Program Prior Authorization Request for Stem Cell or Renal Transplant
- F00080: CSHCN Services Program Prior Authorization Request for Transportation of the Remains of Deceased Clients
- F00097: CSHCN Services Program Wheelchair Seating Evaluation Form
- F00137: CSHCN Services Program Genetic Testing for Hereditary Breast and/or Ovarian Cancer Prior Authorization Form
- F00141: CSHCN Services Program Prescribed Pediatric Extended Care (PPEC) Services Prior Authorization Request Form
- F00148: CSHCN Services Program Authorization and Prior Authorization Request for Cardiorespiratory Monitor (CRM) Form
- F00149: CSHCN Services Program Prior Authorization Request for Pulse Oximeter Form
- F00150: CSHCN Services Program Prior Authorization Request for Secretion and Mucus Clearance Devices Form
- F00151: CSHCN Services Program Prior Authorization Request for Continuous Positive Airway Pressure (CPAP) or Respiratory Assist Device (RAD) Form
- F00152: CSHCN Services Program Prior Authorization Request for Oxygen Therapy Form
- Children with Special Health Care Needs (CSHCN) Services Program Client Drug Co-Pay Reimbursement Request Form
For more information, call the TMHP-CSHCN Services Program Contact Center at 800-568-2413.