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SHARS SLP and Audiology Providers Can Enroll as ORP Providers Effective July 3, 2023

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Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to Medicaid members who are enrolled in their MCO. Administrative procedures, such as prior authorization, precertification, referrals, and claims and encounter data filing, may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the member’s specific MCO for details.

Effective July 3, 2023, School Health and Related Services (SHARS) speech-language pathology (SLP) and audiology providers can enroll in the Provider Enrollment and Management System (PEMS) as an ordering, referring, or prescribing (ORP) provider.

Providers may refer to the PEMS Instructional Site for guidance on creating the ORP practice locations. ORP applicants should confirm that they are not billing for services at the practice location, and that they are not a member of a group.

For additional information on provider enrollment, refer to the Texas Medicaid Provider Procedures Manual (TMPPM):

  • School Health and Related Services (SHARS) Handbook
  • Section 1: Provider Enrollment and Responsibilities (Vol. 1, General Information)

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