WARNING: THIS IS A TEXAS HEALTH AND HUMAN SERVICES INFORMATION RESOURCES SYSTEM THAT CONTAINS STATE AND/OR U.S. GOVERNMENT INFORMATION. BY USING THIS SYSTEM YOU ACKNOWLEDGE AND AGREE THAT YOU HAVE NO RIGHT OF PRIVACY IN CONNECTION WITH YOUR USE OF THE SYSTEM OR YOUR ACCESS TO THE INFORMATION CONTAINED WITHIN IT. BY ACCESSING AND USING THIS SYSTEM YOU ARE CONSENTING TO THE MONITORING OF YOUR USE OF THE SYSTEM, AND TO SECURITY ASSESSMENT AND AUDITING ACTIVITIES THAT MAY BE USED FOR LAW ENFORCEMENT OR OTHER LEGALLY PERMISSIBLE PURPOSES. ANY UNAUTHORIZED USE OR ACCESS, OR ANY UNAUTHORIZED ATTEMPTS TO USE OR ACCESS, THIS SYSTEM MAY SUBJECT YOU TO DISCIPLINARY ACTION, SANCTIONS, CIVIL PENALTIES, OR CRIMINAL PROSECUTION TO THE EXTENT PERMITTED UNDER APPLICABLE LAW.
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AMA/ADA End User License Agreement
LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT® ")

You, your employees and agents are authorized to use CPT only as contained in materials on the Texas Medicaid & Healthcare Partnership (TMHP) website solely for your own personal use in directly participating in healthcare programs administered by THHS. You acknowledge that AMA holds all copyright, trademark and other rights in CPT.

Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized herein must be obtained through the American Medical Association, Intellectual Property Services, 515 N. State Street, Chicago, Illinois, 60610. Applications are available at the American Medical Association website, www.ama-assn.org/go/cpt.

U.S. Government Rights

This product includes CPT which is commercial technical data and/or computer databases and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer databases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (November 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements.

Disclaimer of Warranties and Liabilities

CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the American Medical Association (AMA) is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this product is with THHS, and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this product.

This Agreement will terminate upon notice if you violate its terms. The AMA is a third party beneficiary to this Agreement.

Should the for egoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by clicking below on the button labeled "accept".

THE LICENSE GRANTED HEREIN IS EXPRESSLY CONTINUED UPON YOUR ACCEPTANCE OF ALL TERMS AND CONDITIONS CONTAINED IN THIS AGREEMENT. BY CLICKING BELOW ON THE BUTTON LABELED "ACCEPT", YOU HEREBY ACKNOWLEDGE THAT YOU HAVE READ, UNDERSTOOD, AND AGREED TO ALL TERMS AND CONDITIONS SET FORTH IN THIS AGREEMENT.

IF YOU DO NO AGREE WITH ALL TERMS AND CONDITIONS SET FORTH HEREIN, CLICK BELOW ON THE BUTTON LABELED "DO NOT ACCEPT" AND EXIT FROM THIS COMPUTER SCREEN.

IF YOU ARE ACTING ON BEHALF OF AN ORGANIZATION, YOU REPRESENT THAT YOU ARE AUTHORIZED TO ACT ON BEHALF OF SUCH ORGANIZATION AND THAT YOUR ACCEPTANCE OF THE TERMS OF THIS AGREEMENT CREATES A LEGALLY ENFORCEABLE OBLIGATION OF THE ORGANIZATION. AS USED HEREIN, "YOU" AND "YOUR" REFER TO YOU AND ANY ORGANIZATION ON BEHALF OF WHICH YOU ARE ACTING.

1. Subject to the terms and conditions contained in this Agreement, you, your employees and agents are authorized to use CDT only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. Use of CDT is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights included in the materials.

2. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CDT for resale and/or license, transferring copies of CDT to any party not bound by this agreement, creating any modified or derivative work of CDT, or making any commercial use of CDT. License to use CDT for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago IL 60611. Applications are available at the American Dental Association web site, http://www.ADA.org.

3. U.S. GOVERNMENT RIGHTS. Applicable Federal Acquisition Regulation Clauses (FARS)\Department of Defense Federal Acquisition Regulation Supplement (DFARS) Restrictions Apply to Government Use. This product includes CDT, which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable, which was developed exclusively at private expense by the American Dental Association, 211 East Chicago Avenue, Chicago Illinois, 60611. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal Procurements.

4. ADA DISCLAIMER OF WARRANTIES AND LIABILITIES. CDT is provided “as is” without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. No fee schedules, basic unit, relative values or related listings are included in CDT. The ADA does no t directly or indirectly practice medicine or dispense dental services. The sole responsibility for the software, including any CDT and other content contained therein, is with TMHP or the CMS; and no endorsement by the ADA is intended or implied. The ADA expressly disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This Agreement will terminate upon notice to you if you violate the terms of the Agreement. The ADA is a third party beneficiary to this Agreement.

5. CMS DISCLAIMER. The scope of this license is determined by the ADA, the copyright holder. Any questions pertaining to the license or use of the CDT should be addressed to the ADA. End Users do not act for or on behalf of the CMS. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CDT. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL COVERED BY THIS LICENSE. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.

The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement. If the foregoing terms and conditions are acceptable to you, please indicate your agreement by clicking below on the button labeled "ACCEPT". If you do not agree to the terms and conditions, you may not access or use the software. Instead, you must exit from this computer screen.

Preventing Medicaid Enrollment Delays: Ensure Your Medicare Information Is Current and Accurate

Last updated on 10/16/2026

The Texas Health and Human Services Commission (HHSC) is revising its provider enrollment review process to reinforce the requirement for accurate, complete, and consistent disclosure of ownership, creditor, principal, subcontractor, and related provider information.

This revision is intended to strengthen program integrity across Texas Medicaid, the Children’s Health Insurance Program (CHIP), and other Texas Health and Human Services (HHS) programs to support timely and consistent application review and to reduce deficiencies caused by conflicting information.

Dual Providers

If an organizational provider participates in both Medicare and Texas Medicaid, that provider is expected to make accurate and consistent disclosures to each program. Specifically, the following information for each Owner, Creditor, or Principal (OCP) of the practice must be consistent across both Medicare and Texas Medicaid records:

Owner/Creditor/Principal Name (First and Last)
Owner/Creditor/Principal Date of Birth (DOB)
Owner/Creditor/Principal Social Security number (SSN)
Legal Entity’s name, if applicable
Legal Entity’s federal Employer Identification Number (EIN), if applicable

Refer to the Texas Medicaid Provider Procedures Manual (TMPPM), section 1.1.9.3, “Owner/Creditor/Principal Entry” and section 1.1.9.4, “Disclosure of Ownership and Control Interest Statement.”

Preventing Processing Delays

To reduce application processing delays, providers are encouraged to review and resolve any discrepancies between their Texas Medicaid and Medicare enrollment records as soon as possible and before their next revalidation.

Discrepancies between Medicare and Texas Medicaid records may result in a deficiency delaying the enrollment process.

To help prevent delays, providers should ensure that all their information is accurate, consistent, and complete upon submission by:

Reviewing both Medicare and Texas Medicaid records for matching provider, demographic, and enrollment details, including consistent disclosure of ownership, creditor, principal, subcontractor, and any additional disclosures required for nursing facilities.
Correcting any inconsistencies.
Confirming that all required information is complete and accurate.

Important: Providers who submit data element changes through the Provider Enrollment and Management System (PEMS) Maintenance function must allow up to 30 business days from the date on which the Texas Medicaid & Healthcare Partnership (TMHP) receives the form before the provider will be able to complete the revalidation application in PEMS. This period is required for the changes to take effect.

Providers must obtain approval for any updates to their Medicare enrollment before they can submit any updates or a new enrollment request to Texas Medicaid.

Ownership Disclosure Requirements

Providers must include all the identifying information outlined above for each person or entity ownership or control interest.

A Person or Entity with an ownership or control interest means a person or corporation that meets one of the following criteria:

They have an ownership interest totaling 5% or more in a disclosing entity.
They have an indirect ownership interest equal to 5% or more in a disclosing entity.
They have a combination of direct and indirect ownership interests equal to 5% or more in a disclosing entity.
They own an interest of 5% or more in any mortgage, deed of trust, note, or other obligation secured by the disclosing entity if that interest equals at least 5% of the value of the property or assets of the disclosing entity.
They are an officer or director of a disclosing entity that is organized as a corporation.
They are a partner in a disclosing entity that is organized as a partnership.

Total ownership should always equal 100% unless otherwise noted in the instructions. If ownership does not total 100%, the provider must explain the discrepancy.

Creditor Disclosure Requirements

Providers must list each creditor with a security interest in a debt that is owed by the provider if the creditor’s security interest is protected by at least 5% of the provider’s property.

Principal Disclosure Requirements

Providers must list the following principals:

All corporate officers and directors, limited and non-limited partners, and shareholders of a provider entity (including any professional corporations, professional associations, or limited liability companies in those categories)
All managing employees or agents who exercise operational or managerial control or who directly or indirectly manage the conduct or day-to-day operations of the provider, including but not limited to On-Site Manager, Pharmacist in Charge, Medical Director, Director of Nursing, Director of Operations, Supervising Licensed Practitioner, or other similar positions
All individuals, companies, firms, corporations, employees, independent contractors, entities, or associations who have been expressly granted the authority to act for or on behalf of the provider

Subcontractor Disclosure Requirements

A subcontractor is defined as one of the following:

An individual, agency, or organization to which a disclosing entity has contracted or delegated some of its management functions or responsibilities of providing all or part of the goods, services, work, materials required, or medical care to its patients
An individual, agency, or organization with which a fiscal agent has entered into a contract, agreement, purchase order, or lease (or leases of real property) to obtain space, supplies, equipment, or services provided under the Texas Medicaid agreement

If a provider contracts or proposes to contract with a management company to perform any services related to the provider's participation in HHSC programs, the provider is required to fully disclose all levels of ownership or control interest in the management company and all entities and all individuals at each level of ownership, from the ownership of the management company to the ownership of each successive ownership entity. The provider is also required to disclose all managing employees at each level of ownership.

Additional Disclosure Requirements for Nursing Facilities

In addition to all other disclosure requirements listed above, a nursing facility (as defined in section 1919(a) of the Social Security Act) is required to disclose any individual, including a general manager, business manager, administrator, director, or consultant, who directly or indirectly manages, advises, or supervises any element of the practices, finances, or operations of the facility.

Additional communication and educational videos will be posted soon.

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