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New Medicare-Only Program Enrollment Effective June 30, 2023

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Effective June 30, 2023, providers that perform Medicare-only services will be able to enroll in Texas Medicaid as a Medicare-only provider. As a result, the Texas Health and Human Services Commission (HHSC) is adding a new Medicare-only provider type to the Provider Enrollment and Management System (PEMS).

The Medicare-only provider type (PT) can be used by providers that only render Medicare services not covered by Medicaid (Medicare-only services) or that have a provider type not recognized by Medicaid.

Per Title 42 Code of Federal Regulations (CFR) 455.410(d), Medicare-only providers can enroll in Texas Medicaid and submit Medicare crossover claims to HHSC for proof of Medicaid nonpayment in a Remittance and Status (R&S) Report. With this proof of nonpayment, Medicare-only providers may pursue Medicare reimbursement for these claims.

Provider Enrollment Through the Provider Enrollment and Management System (PEMS)

The requirements for Medicare-only enrollment through PEMS are as follows:

  • Providers must be actively enrolled in Medicare.
  • All facilities and individual (nonperforming) providers must be enrolled in Medicare with one of the following taxonomy codes:

Taxonomy Codes

103TE1000X

106E00000X

174H00000X

2083S0010X

229N00000X

103TW0100X

111NI0013X

273100000X

2084E0001X

335U00000X

103TM1700X

1223S0112X

2083A0100X

2084S0012X

103TP2700X

156FX1700X

2083P0500X

231HA2500X

106S00000X

156FX1800X

2083T0002X

291900000X

Note: The following providers are not eligible to enroll as Medicare-only providers:

  • Providers that are currently enrolled in Texas Medicaid
  • Providers that render, refer, or prescribe Medicaid services

Claims

Medicare-only providers can submit Medicare crossover claims with dates of service on or after January 1, 2022, to receive the R&S Report that shows Medicaid nonpayment. The Texas Medicaid & Healthcare Partnership (TMHP) will not pay claims for Medicaid-covered services that are submitted by Medicare-only providers.

Note: Medicare-only providers may request alternative documentation to an R&S Report per CFR 413.89(iii)(B) for Medicare crossover claims that were submitted on or after January 1, 2022, and prior to their Medicaid enrollment date. These providers should send an email request to HHSC at managed_care_initiatives@hhs.texas.gov. HHSC will review these requests on a case-by-case basis.

For more information, call the TMHP Contact Center at 800-925-9126.