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Individual Therapists in a SHARS Setting That Receive Notification of No Claims Activity Have Six Months to Prevent Enrollment Termination

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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.

Reminder: The Texas Medicaid & Healthcare Partnership (TMHP) disenrolls National Provider Identifiers (NPIs) that exceed 24 months with no claims activity. To avoid terminating NPIs that should remain active, TMHP sends a courtesy letter to all providers with NPIs that have been identified as having no claims activity over the previous 18 months.

It is possible for therapists who treat Medicaid clients in a School and Health Related Services (SHARS) setting to receive such a courtesy letter.

How SHARS Therapists Can Prevent NPI Termination

Therapists who treat Medicaid clients in a SHARS setting and receive a courtesy letter about no claims activity should submit the following information to TMHP to prevent the termination of their NPI:

A copy of the courtesy letter about no claims activity with a signed statement at the bottom of the letter that the provider does not wish to have their NPI terminated because they are continuing to treat Medicaid clients in a SHARS setting. The letter will also need to include the NPI of the SHARS entity for which they provide services.

Providers should send the above information to the following address:

Texas Medicaid & Healthcare Partnership
PO Box 202978
Austin, TX 78720-0978

Note: TMHP must receive this information within six months of the date on the courtesy letter to prevent the NPI from being terminated.

Consequence of Not Submitting Required Information

If TMHP does not receive the above information, TMHP will terminate an NPI after 24 months without claim activity. TMHP will send the provider a termination letter and apply a payment denial code to the NPI. If a provider’s Medicaid NPI is terminated, any enrollments with any Medicaid MCOs or the Children with Special Health Care Needs (CSHCN) Services Program will also be terminated. Claims that are submitted for a terminated NPI after the payment denial code has been applied will be denied.

To have the payment denial code removed from an NPI, the provider must submit a completed application for the state health care program in which they wish to enroll, and the application must be approved. The information on this application must match exactly the information currently on the provider’s file for the payment denial code to be removed.

Providers can go to the TMHP Provider Enrollment web page to reenroll.

Effective July 3, 2023, SHARS speech-language pathology (SLP) and audiology providers can enroll as ordering, referring, or prescribing providers (ORPs). Refer to the web article that was posted on on June 21, 2023.

For additional assistance, email the Provider Relations mailbox at

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