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Licenses/Certifications Accreditations

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Maintenance—Licenses

Instructions for completing the Licenses/Certifications Accreditations Page

Instructions for updating the Licenses/Certifications Accreditations Page

Select the Application Type from the left navigation menu.

Click +Add License/Certification/Accreditation to add each of the professional healthcare licenses, certifications, or accreditations required for your NPI.

Review the existing License/Certification/Accreditation information associated to your "Enrollment Record" to ensure it is accurate.  If you require any edits, click the ellipses icon (...) and then click Open to provide updates to the fields accordingly.

If applicable, make any edits to the available fields. Otherwise, proceed to Step 2.

Effective Date—Confirm or update the effective date for the license, certification, or accreditation.

Expiration Date—Confirm or update the expiration date for the license, certification, or accreditation.

Type - Select the appropriate “Type” for your License/Certification/Accreditation from the drop-down menu.

For Type—Certification, if you are one of the following provider types, you will be required to provide your certification information:

Issuer - Select the appropriate “Issuer” for your License/Certification/Accreditation from the drop-down menu.

Note: If none of the available selections are applicable, select "Other" or "Out of State" based on your situation. You will be prompted to enter the issuing agency in the “Other Issuer” field.

Number - Enter the Licenses/Certification/Accreditation “Number”.

Effective Date - Enter the License/Certification/Accreditation “Effective Date”.

Expiration Date - Enter the License/Certification/Accreditation “Expiration Date”.

State Issuer - For licenses, select the appropriate “State Issuer” from the drop-down menu.

Note: If none of the available selections for the “State Issuer” are applicable to your situation, select “Other”.

Other Issuer -  Enter the “Other Issuer” of the License/Certification/Accreditation.

For Type – Certification, if you are one of the following provider types, you will be required to provide your certification information:

National Registry of Rehabilitation Technology Suppliers (NRRTS) – Qualified Rehabilitation Professionals. (QRP)

Rehabilitation Engineering and Assistive Technology Society of North America (RESNA – Qualified. Rehabilitation Professionals (QRP)

Issuer: National Registry of Rehabilitation Technology Suppliers (NRRTS)—Qualified Rehabilitation. Professionals (QRP)

Issuer: Rehabilitation Engineering and Assistive Technology Society of North America (RESNA)—Qualified. Rehabilitation Professionals (QRP)

For all other providers, you may enter your certification if applicable:

Issuer: State of Texas Mammography.

Issuer: Other.

Number—Verify the License/Certification/Accreditation “Number.”

Number—Enter the License/Certification/Accreditation “Number.”

Effective Date—Verify the License/Certification/Accreditation “Effective Date.”

Effective Date—Enter the effective date for the license, certification, or accreditation.

Expiration Date—Enter the License/Certification/Accreditation “Expiration Date”.

State Issuer—For licenses, select the appropriate “State Issuer” from the drop-down menu.

Note: If none of the available selections for the “State Issuer” are applicable to your situation, select “Other.”

Other Issuer—Enter the “Other Issuer” of the License/Certification/Accreditation.

If you selected State of Texas Mammography Accreditation Program, the following will appear:

Address Line 1—Confirm or update the street address for Clinical Laboratory Improvement Amendments (CLIA) services.

Address Line 2—Confirm or update the suite/building number.

City—Confirm or update the city.

State—Confirm or update the state.

Zip Code—Confirm or update the ZIP Code.

Zip Code+4—Confirm or update the ZIP Code+4.

For Type—Accreditation, Issuer - Clinical Laboratory Improvement Amendments (CLIA), the following additional fields appear.

CLIA Type—Confirm or select one of the options in the drop-down menu.

Address Line 1—Confirm or update the street address for CLIA services.

Address Line 2—Confirm or update the Suite/Building Number.

City—Confirm or update the City.

State—Confirm or update the State.

Zip Code—Confirm or update the ZIP Code.

Zip Code+4—Confirm or update the ZIP Code+4.

Laboratory Certification(s)—Confirm the laboratory certifications associated to your CLIA or click +Add Laboratory Certification to add each Laboratory Certification.

To make edits to an existing laboratory certification, click the ellipses icon (...) and click Open.

Lab Certification (Code)—Confirm or select a code from the drop-down menu.

  Effective Date—Confirm or update the effective date for the certification.

Expiration Date—Confirm or update the expiration date to match the CLIA expiration date.  

If applicable, upload a copy of the license/certification/accreditation. 

  Note: TMHP verifies licensure, certification, or accreditation information using available resources. If TMHP cannot verify information during the review process, it is the providers’ responsibility to provide a copy of the license, certification, or accreditation to TMHP. 

 Click Save.

If you require an additional license/certification/accreditation to be added, click +Add License/Certification/Accreditation to add each of the professional healthcare licenses, certifications, or accreditations required for your National Provider Identifier (NPI). Otherwise, proceed to Step 3.

Type—Select the appropriate type for your License/Certification/Accreditation from the drop-down menu.

Issuer—Select the appropriate issuer for your License/Certification/Accreditation from the drop-down menu.

Note: If none of the available selections are applicable, select Other or Out of State based on your situation. You will be prompted to enter the issuing agency in the “Other Issuer” field.

Number—Enter the license, certification or accreditation number.

Effective Date—Enter the effective date for the license, certification or accreditation.

Expiration Date—Enter the expiration date for the license, certification or accreditation.

State Issuer—For licenses, select the appropriate state issuer from the drop-down menu.

Note: If none of the available options in the “State Issuer” field are applicable to your situation, select Other.

Other Issuer—Enter the “Other Issuer” of the license, certification, or accreditation.

For Type—Accreditation, Issuer: Clinical Laboratory Improvement Amendments (CLIA), the following additional fields appear.

CLIA Type—Select the appropriate “CLIA Type” from the drop-down menu.

Address Line 1—Enter the street address associated to your CLIA certificate.

Address Line 2—If applicable, enter the Suite/Building Number associated to your CLIA certificate.

City—Enter the “City” associated to your CLIA certificate.

State—Enter the “State” associated to your CLIA certificate.

Zip Code—Enter the “ZIP Code” associated to your CLIA certificate.

Zip Code+4—Enter the “ZIP Code+4” associated to your CLIA certificate.

Laboratory Certification(s)—Click +Add Laboratory Certification to add any laboratory certifications associated to your CLIA certificate. Repeat for each laboratory certification.

Lab Certification (Code)—Select a code from the drop-down menu.

Effective Date—Enter the effective date for the certification.

Expiration Date—Enter the expiration date to match the CLIA expiration date.

To update your Healthy Texas Women attestation:

For Type – Attestation -Healthy Texas Women, the following additional fields appear:

Check “Yes” to “Affirm that the statements listed in the certification are true and correct”.

Checking the box will auto-populate the Effective Date and Expiration Date to the Current date and last day of the Calendar Year, respectively.

If applicable, upload a copy of the license, certification, or accreditation.

Note: TMHP verifies licensure, certification, and accreditation information using available resources. If TMHP cannot verify information during the review process, it is the providers’ responsibility to provide a copy of the license, certification or accreditation to TMHP.

Click Save.

If you require one of the added licenses, certifications, or accreditations to be removed from your enrollment application, click on the ellipses icon (…) and click Remove.

A pop-up warning modal will show asking “Are you sure you want to remove this record?”. If you wish to continue, click Ok. Click Cancel if you wish to keep the information on your enrollment record.

Repeat for each professional healthcare license, certification, or accreditation for your National Provider Identifier (NPI).

If you require one of your existing licenses, certifications, accreditations to be removed from your enrollment record, click the ellipses icon (…) and click Remove.

 A pop-up warning modal will show asking “Are you sure you want to remove this record?”. If you wish to continue, click Ok. Click Cancel if you wish to keep the information on your enrollment record.

Access the left navigation and select the next available page to continue entering your application.

Repeat for each professional healthcare license, certification, or accreditation for your National Provider Identifier (NPI).

Access the left navigation and select the next available page to continue entering your application.

When all changes have been completed, click Submit All Changes.

Maintenance—Licenses

Instructions for completing the Licenses/Certifications Accreditations Page

Instructions for updating the Licenses/Certifications Accreditations Page

Instructions for updating the Licenses/Certifications Accreditations Page

Instructions for updating the Licenses/Certifications Accreditations Page

Instructions for updating the Licenses/Certifications Accreditations Page

Click +Add License/Certification/Accreditation to add each of the professional healthcare licenses, certifications, or accreditations required for your NPI.

Review the existing License/Certification/Accreditation information associated to your "Enrollment Record" to ensure it is accurate.  If you require any edits, click the ellipses icon (...) and then click Open to provide updates to the fields accordingly.

If applicable, make any edits to the available fields. Otherwise, proceed to Step 2.

Effective Date – Confirm or update the License/Certification/Accreditation “Effective Date”.

Expiration Date – Confirm or update the License/Certification/Accreditation “Expiration Date”.

Review the existing License/Certification/Accreditation information associated to your "Enrollment Record" to ensure it is accurate.  If you require any edits, click the ellipses icon (...) and then click Open to provide updates to the fields accordingly.

If applicable, make any edits to the available fields. Otherwise, proceed to Step 2.

For Type—License

Issuer - Confirm or select one of the options in the drop-down menu.

Number - Confirm or select one of the options in the drop-down menu.

Type - Confirm or select one of the options in the drop-down menu.

Effective Date – Confirm or update the Certification “Effective Date”.

Expiration Date – Confirm or update the Certification “Expiration Date”.

State Issuer – Confirm or select one of the options in the drop-down menu.

Review the existing License/Certification/Accreditation information associated to your "Enrollment Record" to ensure it is accurate.  If you require any edits, click the ellipses icon (...) and then click Open to provide updates to the fields accordingly.

If applicable, make any edits to the available fields. Otherwise, proceed to Step 2.

Effective Date – Confirm or update the License/Certification/Accreditation “Effective Date”.

Expiration Date – Confirm or update the License/Certification/Accreditation “Expiration Date”.

Review the Maintenance License/Certification/Accreditation information associated to your "Enrollment Record" to ensure it is accurate.  If you require any edits, click the ellipses icon (...) and then click Open to provide updates to the fields accordingly.

If applicable, make any edits to the available fields. Otherwise, proceed to Step 2.

Effective Date—Confirm or update the effective date for the license, certification, or accreditation.

Expiration Date—Confirm or update the expiration date for the license, certification, or accreditation.

Type - Select the appropriate “Type” for your License/Certification/Accreditation from the drop-down menu.

For Type—Certification, if you are one of the following provider types, you will be required to provide your certification information:

For Type—Certification

For Type—Certification, if you are one of the following provider types, you will be required to provide your certification information:

Issuer - Select the appropriate “Issuer” for your License/Certification/Accreditation from the drop-down menu.

Note: If none of the available selections are applicable, select "Other" or "Out of State" based on your situation. You will be prompted to enter the issuing agency in the “Other Issuer” field.

Number - Enter the Licenses/Certification/Accreditation “Number”.

Effective Date - Enter the License/Certification/Accreditation “Effective Date”.

Expiration Date - Enter the License/Certification/Accreditation “Expiration Date”.

State Issuer - For licenses, select the appropriate “State Issuer” from the drop-down menu.

Note: If none of the available selections for the “State Issuer” are applicable to your situation, select “Other”.

Other Issuer -  Enter the “Other Issuer” of the License/Certification/Accreditation.

For Type – Certification, if you are one of the following provider types, you will be required to provide your certification information:

National Registry of Rehabilitation Technology Suppliers (NRRTS) – Qualified Rehabilitation Professionals (QRP).

Rehabilitation Engineering and Assistive Technology Society of North America (RESNA – Qualified Rehabilitation Professionals (QRP).

Issuer: National Registry of Rehabilitation Technology Suppliers (NRRTS)—Qualified Rehabilitation Professionals (QRP).

Issuer: Rehabilitation Engineering and Assistive Technology Society of North America (RESNA)—Qualified Rehabilitation Professionals (QRP).

Issuer: National Registry of Rehabilitation Technology Suppliers (NRRTS)—Qualified Rehabilitation Professionals (QRP).

Issuer: Rehabilitation Engineering and Assistive Technology Society of North America (RESNA)—Qualified Rehabilitation Professionals (QRP).

Issuer: National Registry of Rehabilitation Technology Suppliers (NRRTS)—Qualified Rehabilitation Professionals (QRP).

Issuer: Rehabilitation Engineering and Assistive Technology Society of North America (RESNA)—Qualified Rehabilitation Professionals (QRP).

For all other providers, you may enter your certification if applicable:

For all other providers, you may enter your certification if applicable:

For all other providers, you may enter your certification if applicable:

For all other providers, you may enter your certification if applicable:

Issuer: Other.

Issuer: Other.

Issuer: Other.

Issuer: Other.

Number—Enter the License/Certification/Accreditation “Number.”

Effective Date - Enter the License/Certification/Accreditation “Effective Date”.

Number—Verify the License/Certification/Accreditation “Number.”

Effective Date—Verify the License/Certification/Accreditation “Effective Date.”

Effective Date—Enter the effective date for the license, certification, or accreditation.

Number—Verify the Certification “Number”.

Effective Date—Verify the Certification “Effective Date”.

Number—Verify the License/Certification/Accreditation “Number.”

Effective Date—Verify the License/Certification/Accreditation “Effective Date.”

Expiration Date—Enter the License/Certification/Accreditation “Expiration Date”.

State Issuer—For licenses, select the appropriate “State Issuer” from the drop-down menu.

Note: If none of the available selections for the “State Issuer” are applicable to your situation, select “Other.”

Other Issuer—Enter the “Other Issuer” of the License/Certification/Accreditation.

If you selected State of Texas Mammography Accreditation Program, the following will appear:

Address Line 1—Confirm or update the street address.

Address Line 2—Confirm or update the suite/building number.

City—Confirm or update the city.

State—Confirm or update the state.

Zip Code—Confirm or update the ZIP Code.

Zip Code+4—Confirm or update the ZIP Code+4.

Expiration Date—Enter the License/Certification/Accreditation “Expiration Date”.

State Issuer—For licenses, select the appropriate “State Issuer” from the drop-down menu.

Note: If none of the available selections for the “State Issuer” are applicable to your situation, select “Other.”

Other Issuer—Enter the “Other Issuer” of the License/Certification/Accreditation.

If you selected State of Texas Mammography Accreditation Program, the following will appear:

Address Line 1—Confirm or update the street address.

Address Line 2—Confirm or update the suite/building number.

City—Confirm or update the city.

State—Confirm or update the state.

Zip Code—Confirm or update the ZIP Code.

Zip Code+4—Confirm or update the ZIP Code+4.

Expiration Date—Enter the Certification “Expiration Date”.

Other Issuer—Enter the “Other Issuer” of the Certification.

Expiration Date—Enter the License/Certification/Accreditation “Expiration Date”.

State Issuer—For licenses, select the appropriate “State Issuer” from the drop-down menu.

Note: If none of the available selections for the “State Issuer” are applicable to your situation, select “Other.”

Other Issuer—Enter the “Other Issuer” of the License/Certification/Accreditation.

If you selected State of Texas Mammography Accreditation Program, the following will appear:

Address Line 1—Confirm or update the street address.

Address Line 2—Confirm or update the suite/building number.

City—Confirm or update the city.

State—Confirm or update the state.

Zip Code—Confirm or update the ZIP Code.

Zip Code+4—Confirm or update the ZIP Code+4.

Address Line 1—Confirm or update the street address .

Address Line 2—Confirm or update the Suite/Building Number.

City—Confirm or update the City.

State—Confirm or update the State.

Zip Code—Confirm or update the ZIP Code.

Zip Code+4—Confirm or update the ZIP Code+4.

To make edits to an existing laboratory certification, click the ellipses icon (...) and click Open.

Lab Certification (Code)—Confirm or select a code from the drop-down menu.

  Effective Date—Confirm or update the effective date for the certification.

Expiration Date—Confirm or update the expiration date.

If applicable, upload a copy of the license/certification/accreditation. 

  Note: TMHP verifies licensure, certification, or accreditation information using available resources. If TMHP cannot verify information during the review process, it is the providers’ responsibility to provide a copy of the license, certification, or accreditation to TMHP. 

 Click Save.

If you require an additional license/certification/accreditation to be added, click +Add License/Certification/Accreditation to add each of the professional healthcare licenses, certifications, or accreditations required for your National Provider Identifier (NPI). Otherwise, proceed to Step 3.

For Type—Accreditation, Issuer.

—Confirm or select one of the options in the drop-down menu.

Issuer: Other.

Number: Confirm or update the Number.

Effective Date: Confirm or update the Effective Date.

Expiration Date: Confirm or update the Expiration Date.

Other Issuer: Confirm or update the Other Issuer.

If applicable, upload a copy of the license/certification/accreditation by selecting “Click here to select filed” button at the bottom of the page. 

  Note: TMHP verifies licensure, certification, or accreditation information using available resources. If TMHP cannot verify information during the review process, it is the providers’ responsibility to provide a copy of the license, certification, or accreditation to TMHP. 

 Click Save.

If you require an additional license/certification/accreditation to be added, click +Add License/Certification/Accreditation to add each of the professional healthcare licenses, certifications, or accreditations required for your National Provider Identifier (NPI). Otherwise, proceed to Step 3.

Note: Clinical Lab Improvement Amendments (CLIA) are not applicable for Performing Provider enrollments.

For Type—Accreditation, Issuer.

Type—Confirm or select one of the options in the drop-down menu.

Address Line 1—Confirm or update the street address.

Address Line 2—Confirm or update the Suite/Building Number.

City—Confirm or update the City.

State—Confirm or update the State.

Zip Code—Confirm or update the ZIP Code.

Zip Code+4—Confirm or update the ZIP Code+4.

To make edits to an existing laboratory certification, click the ellipses icon (...) and click Open.

Lab Certification (Code)—Confirm or select a code from the drop-down menu.

  Effective Date—Confirm or update the effective date for the certification.

Expiration Date—Confirm or update the expiration date.

If applicable, upload a copy of the license/certification/accreditation. 

  Note: TMHP verifies licensure, certification, or accreditation information using available resources. If TMHP cannot verify information during the review process, it is the providers’ responsibility to provide a copy of the license, certification, or accreditation to TMHP. 

 Click Save.

If you require an additional license/certification/accreditation to be added, click +Add License/Certification/Accreditation to add each of the professional healthcare licenses, certifications, or accreditations required for your National Provider Identifier (NPI). Otherwise, proceed to Step 3.

For Type—Accreditation, Issuer.

Type—Confirm or select one of the options in the drop-down menu.

Address Line 1—Confirm or update the street address.

Address Line 2—Confirm or update the Suite/Building Number.

City—Confirm or update the City.

State—Confirm or update the State.

Zip Code—Confirm or update the ZIP Code.

Zip Code+4—Confirm or update the ZIP Code+4.

To make edits to an existing laboratory certification, click the ellipses icon (...) and click Open.

Lab Certification (Code)—Confirm or select a code from the drop-down menu.

  Effective Date—Confirm or update the effective date for the certification.

Expiration Date—Confirm or update the expiration date.

If applicable, upload a copy of the license/certification/accreditation. 

  Note: TMHP verifies licensure, certification, or accreditation information using available resources. If TMHP cannot verify information during the review process, it is the providers’ responsibility to provide a copy of the license, certification, or accreditation to TMHP. 

 Click Save.

If you require an additional license/certification/accreditation to be added, click +Add License/Certification/Accreditation to add each of the professional healthcare licenses, certifications, or accreditations required for your National Provider Identifier (NPI). Otherwise, proceed to Step 3.

For Type – Attestation -Healthy Texas Women, the following additional fields appear:

Check “Yes” to “Affirm that the statements listed in the certification are true and correct”.

Checking the box will auto-populate the Effective Date and Expiration Date to the Current date and last day of the Calendar Year, respectively.

Type—Select the appropriate type for your License/Certification/Accreditation from the drop-down menu.

Issuer—Select the appropriate issuer for your License/Certification/Accreditation from the drop-down menu.

Note: If none of the available selections are applicable, select Other or Out of State based on your situation. You will be prompted to enter the issuing agency in the “Other Issuer” field.

Number—Enter the license, certification or accreditation number.

Effective Date—Enter the effective date for the license, certification or accreditation.

Expiration Date—Enter the expiration date for the license, certification or accreditation.

State Issuer—For licenses, select the appropriate state issuer from the drop-down menu.

Note: If none of the available options in the “State Issuer” field are applicable to your situation, select Other.

Other Issuer—Enter the “Other Issuer” of the license, certification, or accreditation.

For Type—Accreditation, Issuer:

Address Line 1—Enter the street address.

Address Line 2—If applicable, enter the Suite/Building Number.

City—Enter the “City” .

State—Enter the “State” .

Zip Code—Enter the “ZIP Code” associated to your CLIA certificate.

Zip Code+4—Enter the “ZIP Code+4” .

Lab Certification (Code)—Select a code from the drop-down menu.

Effective Date—Enter the effective date for the certification.

Expiration Date—Enter the expiration date.

Type—Select the appropriate type for your License/Certification/Accreditation from the drop-down menu.

Issuer—Select the appropriate issuer for your License/Certification/Accreditation from the drop-down menu.

Note: If none of the available selections are applicable, select Other or Out of State based on your situation. You will be prompted to enter the issuing agency in the “Other Issuer” field.

Number—Enter the license, certification or accreditation number.

Effective Date—Enter the effective date for the license, certification or accreditation.

Expiration Date—Enter the expiration date for the license, certification or accreditation.

State Issuer—For licenses, select the appropriate state issuer from the drop-down menu.

Note: If none of the available options in the “State Issuer” field are applicable to your situation, select Other.

Other Issuer—Enter the “Other Issuer” of the license, certification, or accreditation.

Type—Select the appropriate type for your License/Certification/Accreditation from the drop-down menu.

Issuer—Select the appropriate issuer for your License/Certification/Accreditation from the drop-down menu.

Note: If none of the available selections are applicable, select Other or Out of State based on your situation. You will be prompted to enter the issuing agency in the “Other Issuer” field.

Number—Enter the license, certification or accreditation number.

Effective Date—Enter the effective date for the license, certification or accreditation.

Expiration Date—Enter the expiration date for the license, certification or accreditation.

State Issuer—For licenses, select the appropriate state issuer from the drop-down menu.

Note: If none of the available options in the “State Issuer” field are applicable to your situation, select Other.

Other Issuer—Enter the “Other Issuer” of the license, certification, or accreditation.

Address Line 1—Enter the street address .

Address Line 2—If applicable, enter the Suite/Building Number.

City—Enter the “City” .

State—Enter the “State” .

Zip Code—Enter the “ZIP Code” .

Zip Code+4—Enter the “ZIP Code+4” .

Lab Certification (Code)—Select a code from the drop-down menu.

Effective Date—Enter the effective date for the certification.

Expiration Date—Enter the expiration date .

To update your Healthy Texas Women attestation:

For Type – Attestation -Healthy Texas Women, the following additional fields appear:

Check “Yes” to “Affirm that the statements listed in the certification are true and correct”.

Checking the box will auto-populate the Effective Date and Expiration Date to the Current date and last day of the Calendar Year, respectively.

If applicable, upload a copy of the license, certification, or accreditation.

Note: TMHP verifies licensure, certification, and accreditation information using available resources. If TMHP cannot verify information during the review process, it is the providers’ responsibility to provide a copy of the license, certification or accreditation to TMHP

Click Save.

To update your Healthy Texas Women attestation:

For Type – Attestation -Healthy Texas Women, the following additional fields appear:

Check “Yes” to “I Affirm that the statements listed in the certification are true and correct”.

Checking the box will auto-populate the Effective Date and Expiration Date to the Current date and last day of the Calendar Year, respectively.

If applicable, upload a copy of the license, certification, or accreditation.

Note: TMHP verifies licensure, certification, and accreditation information using available resources. If TMHP cannot verify information during the review process, it is the providers’ responsibility to provide a copy of the license, certification or accreditation to TMHP.

Click Save.

To update your Healthy Texas Women attestation:

For Type – Attestation -Healthy Texas Women, the following additional fields appear:

Check “Yes” to “Affirm that the statements listed in the certification are true and correct”.

Checking the box will auto-populate the Effective Date and Expiration Date to the Current date and last day of the Calendar Year, respectively.

If applicable, upload a copy of the license, certification, or accreditation.

Note: TMHP verifies licensure, certification, and accreditation information using available resources. If TMHP cannot verify information during the review process, it is the providers’ responsibility to provide a copy of the license, certification or accreditation to TMHP.

Click Save.

To update your Healthy Texas Women attestation:

For Type – Attestation -Healthy Texas Women, the following additional fields appear:

Check “Yes” to “Affirm that the statements listed in the certification are true and correct”.

Checking the box will auto-populate the Effective Date and Expiration Date to the Current date and last day of the Calendar Year, respectively.

 

Note: TMHP verifies licensure, certification, and accreditation information using available resources. If TMHP cannot verify information during the review process, it is the providers’ responsibility to provide a copy of the license, certification or accreditation to TMHP.

Click Save.

If applicable, upload a copy of the license, certification, or accreditation.

Note: TMHP verifies licensure, certification, and accreditation information using available resources. If TMHP cannot verify information during the review process, it is the providers’ responsibility to provide a copy of the license, certification or accreditation to TMHP.

Click Save.

If you require one of the added licenses, certifications, or accreditations to be removed from your enrollment application, click on the ellipses icon (…) and click Remove.

A pop-up warning modal will show asking “Are you sure you want to remove this record?”. If you wish to continue, click Ok. Click Cancel if you wish to keep the information on your enrollment record.

Repeat for each professional healthcare license, certification, or accreditation for your National Provider Identifier (NPI).

If you require one of your existing licenses, certifications, accreditations to be removed from your enrollment record, click the ellipses icon (…) and click Remove.

 A pop-up warning modal will show asking “Are you sure you want to remove this record?”. If you wish to continue, click Ok. Click Cancel if you wish to keep the information on your enrollment record.

If you require one of your newly added licenses, certifications, accreditations to be removed from your enrollment record, click the ellipses icon (…) and click Remove.

 A pop-up warning modal will show asking “Are you sure you want to remove this record?”. If you wish to continue, click Ok. Click Cancel if you wish to keep the information on your enrollment record.

If you require one of your existing licenses, certifications, accreditations to be removed from your enrollment record, click the ellipses icon (…) and click Remove.

 A pop-up warning modal will show asking “Are you sure you want to remove this record?”. If you wish to continue, click Ok. Click Cancel if you wish to keep the information on your enrollment record.

If you require one of your existing licenses, certifications, accreditations to be removed from your enrollment record, click the ellipses icon (…) and click Remove.

 A pop-up warning modal will show asking “Are you sure you want to remove this record?”. If you wish to continue, click Ok. Click Cancel if you wish to keep the information on your enrollment record.

Access the left navigation and select the next available page to continue entering your application.

Repeat for each professional healthcare license, certification, or accreditation for your National Provider Identifier (NPI).

Repeat for each newly added professional healthcare license, certification, or accreditation for your National Provider Identifier (NPI).

Repeat for each professional healthcare license, certification, or accreditation for your National Provider Identifier (NPI).

Repeat for each professional healthcare license, certification, or accreditation for your National Provider Identifier (NPI).

Access the left navigation and select the next available page to continue entering your application.

Access the left navigation and select the next available page to continue entering your application.

Note: Only newly added licenses, certifications, accreditations can be removed.

The “Used On A Program And Service Detail Record” table at the bottom of each license/certification/accreditation page provides the Practice and Program the license/certification/accreditation is applied to.

Access the left navigation and select the next available page to continue entering your application.

Instructions for completing the Licenses/Certifications Accreditations Page

Click +Add License/Certification/Accreditation to add each of the professional healthcare licenses, certifications, or accreditations required for your NPI.

Type - Select the appropriate “Type” for your License/Certification/Accreditation from the drop-down menu.

Issuer - Select the appropriate “Issuer” for your License/Certification/Accreditation from the drop-down menu.

Note: If none of the available selections are applicable, select "Other" or "Out of State" based on your situation. You will be prompted to enter the issuing agency in the “Other Issuer” field.

Number - Enter the Licenses/Certification/Accreditation “Number”.

Effective Date - Enter the License/Certification/Accreditation “Effective Date”.

Expiration Date - Enter the License/Certification/Accreditation “Expiration Date”.

State Issuer - For licenses, select the appropriate “State Issuer” from the drop-down menu.

Note: If none of the available selections for the “State Issuer” are applicable to your situation, select “Other”.

Other Issuer -  Enter the “Other Issuer” of the License/Certification/Accreditation.

For Type – Certification, if you are one of the following provider types, you will be required to provide your certification information:

National Registry of Rehabilitation Technology Suppliers (NRRTS) – Qualified Rehabilitation Professionals. (QRP)

Rehabilitation Engineering and Assistive Technology Society of North America (RESNA – Qualified. Rehabilitation Professionals (QRP)

For all other providers, you may enter your certification if applicable:

Issuer: State of Texas Mammography.

Issuer: Other.

Number—Enter the License/Certification/Accreditation “Number.”

Expiration Date—Enter the License/Certification/Accreditation “Expiration Date”.

State Issuer—For licenses, select the appropriate “State Issuer” from the drop-down menu.

Note: If none of the available selections for the “State Issuer” are applicable to your situation, select “Other.”

Other Issuer—Enter the “Other Issuer” of the License/Certification/Accreditation.

If you selected State of Texas Mammography Accreditation Program, the following will appear:

Address Line 1—Confirm or update the street address for Clinical Laboratory Improvement Amendments (CLIA) services.

Address Line 2—Confirm or update the suite/building number.

City—Confirm or update the city.

State—Confirm or update the state.

Zip Code—Confirm or update the ZIP Code.

Zip Code+4—Confirm or update the ZIP Code+4.

If you require an additional license/certification/accreditation to be added, click +Add License/Certification/Accreditation to add each of the professional healthcare licenses, certifications, or accreditations required for your National Provider Identifier (NPI). Otherwise, proceed to Step 3.

Type—Select the appropriate type for your License/Certification/Accreditation from the drop-down menu.

Issuer—Select the appropriate issuer for your License/Certification/Accreditation from the drop-down menu.

Note: If none of the available selections are applicable, select Other or Out of State based on your situation. You will be prompted to enter the issuing agency in the “Other Issuer” field.

Number—Enter the license, certification or accreditation number.

Effective Date—Enter the effective date for the license, certification or accreditation.

Expiration Date—Enter the expiration date for the license, certification or accreditation.

State Issuer—For licenses, select the appropriate state issuer from the drop-down menu.

Note: If none of the available options in the “State Issuer” field are applicable to your situation, select Other.

Other Issuer—Enter the “Other Issuer” of the license, certification, or accreditation.

If you require one of the added licenses, certifications, or accreditations to be removed from your enrollment application, click on the ellipses icon (…) and click Remove.

A pop-up warning modal will show asking “Are you sure you want to remove this record?”. If you wish to continue, click Ok. Click Cancel if you wish to keep the information on your enrollment record.

Repeat for each professional healthcare license, certification, or accreditation for your National Provider Identifier (NPI).

Access the left navigation and select the next available page to continue entering your application.

When all changes have been completed, click Submit All Changes.