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Provider Type Checklist

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Required Licenses and Certifications

Patient Protection and Affordable Care Act Information


National Provider Identifier (NPI)

Primary Taxonomy Code

Required Documentation

Out-of-state providers must submit proof that they meet one of the following criteria:

A medical emergency is documented by the attending physician or another provider.

The client’s health would be endangered if they traveled to Texas.

The necessary medical services are more readily available in the state where the client is located.

The customary or general practice for clients in a particular locality is to use the medical resources in another other state.

The services are provided to adopted children who are receiving adoption subsidies.

The services are medically necessary, and providers of such services are limited or not readily available in Texas.

The services are medically necessary services to one or more dually eligible clients (clients who are enrolled in both Medicare and Medicaid).