Instructions for completing the Services Provided section
Instructions for reviewing the Services Provided section
Select the Application Type from the left navigation menu.
Click Add Services Provided.
If needing to add a new practice location Click Add Services Provided.
This will open the “Location Where Services are Provided” sub-page to determine your enrollment type.
Services Provided Sub-page
Location Where Services are Provided
Is this a new location? Select Yes or No:
Select "Yes" if:
This is a new practice location, needing to be added to your existing NPI record.
This is a brand-new enrollment, where as the provider is not enrolled in Texas Medicaid.
If you have not enrolled at this exact location before within any Medicaid program.
Selecting "Yes" will reveal Step 3 below.
If you require changes to the information provided, you will make such changes in sections later within the request.
Select No if:
You have an existing enrollment into a Texas Medicaid and are adding to an existing practice location.
You have are adding a new program/provider type to an existing practice location.
Selecting "Yes" will reveal the following additional information:
Select an existing location—Select from the available locations within the drop-down menu.
Enter the following provider information for the Location you are enrolling into:
If adding a new location enter the following provider information for the Location you are enrolling into:
Type of Location: Select the type of location based on your enrollment type:
Facility: This type of enrollment applies to situations in which licensure or certification applies to the entity. Although individuals working for or with the entity may be licensed or certified in their individual capacity, the enrollment is based on the licensure or certification of the entity. For this reason, facility enrollment does not require enrollment of performing providers.
Group: This type of enrollment applies to healthcare items or services provided under the auspices of a legal entity, such as a partnership, corporation, limited liability company, or professional association, and the individuals providing healthcare items or services are required to be certified or licensed in Texas. The enrollment is under the name and tax identification number of the legal entity.
Note: After the group enrollment record has been enrolled, you must then enroll at least one performing provider associated to your group in order to bill for services provided.
Enter the following provider information for the location you are enrolling into:
Location Name—This name will appear in the practice locations table for each address associated to your enrollment record for quick reference.
Address Line 1—Enter the street address for the practice location where services are performed.
Address Line 2—Enter the suite number or building number information.
City—Enter the city of the location for your practice.
State—Enter the state of the location for your
Zip Code - Enter the ZIP Code of the location for
Zip Code +4—Enter the +4 for the exact location of your practice.
Select Verify Address: Verify that the address that you entered matches the address where services are rendered to clients. You must not enter the accounting, corporate, or mailing address information as the Practice Location, you can provide that information as Additional Address(es) associated to each Practice Location as applicable.
If you require a change to the address, select the checkbox “Click to Change Address”.
Program Participation
Program— From the drop-down menu, select the program in which you are enrolling the practice location
Primary Taxonomy—From the drop-down menu, select an eligible taxonomy code as provided from the National Plan & Provider Enumeration System (NPPES).
Provider Type—From the drop-down menu, select the provider type that corresponds to the available eligible taxonomy codes provided from the National Plan & Provider Enumeration System (NPPES).
Click Save.
Access the left navigation and select the next available page to continue entering your application.
Instructions for completing the Services Provided section
Instructions for reviewing the Services Provided section
Click Add Services Provided.
If needing to add a new practice location Click Add Services Provided.
This will open the “Location Where Services are Provided” sub-page to determine your enrollment type.
Services Provided Sub-page
Location Where Services are Provided
Is this a new location? Select Yes or No:
Select "Yes" if:
This is a new practice location, needing to be added to your existing NPI record.
This is a brand-new enrollment, where as the provider is not enrolled in Texas Medicaid.
If you have not enrolled at this exact location before within any Medicaid program.
Selecting "Yes" will reveal Step 3 below.
If you require changes to the information provided, you will make such changes in sections later within the request.
Select No if:
You have an existing enrollment into a Texas Medicaid and are adding to an existing practice location.
You have are adding a new program/provider type to an existing practice location.
Selecting "Yes" will reveal the following additional information:
Select an existing location—Select from the available locations within the drop-down menu.
Enter the following provider information for the Location you are enrolling into:
If adding a new location enter the following provider information for the Location you are enrolling into:
Type of Location: Select the type of location based on your enrollment type:
Are you a member of a "Group" at this location? – Select Yes or No.
Select "Yes" if:
You are seeking enrollment as a Performing Provider into an Existing Group—This type of enrollment applies to an individual healthcare professional who is licensed or certified in Texas, and who is seeking enrollment under a group. The enrollment is under the tax identification number of the group, and payment is made to the group.
You are seeking enrollment as a Performing Provider into an Existing Group—This type of enrollment applies to an individual healthcare professional who is licensed or certified, and who is seeking enrollment under a group. The enrollment is under the tax identification number of the group, and payment is made to the group.
Selecting "Yes" will reveal the following additional information:
Group NPI–Enter the Group which you are assigning your enrollment into.
Group Name–Enter the Group’s Organization Name
Group Location–Select the existing location on file for the Group within the drop-down menu.
Proceed to "Program Participation."
Select "No" if:
You are seeking enrollment as an Individual. This type of enrollment applies to an individual healthcare professional who is licensed or certified in Texas, and who is seeking enrollment under the name, and social security or tax identification number of the individual. An individual may also enroll as an employee, using the tax identification number of the employer. Certain provider types must enroll as individuals, including dieticians, licensed vocational nurses (LVN), occupational therapists, and speech therapists
You are seeking enrollment as an Individual. This type of enrollment applies to an individual healthcare professional who is licensed or certified, and who is seeking enrollment under the name, and social security or tax identification number of the individual. An individual may also enroll as an employee, using the tax identification number of the employer. Certain provider types must enroll as individuals, including dieticians, licensed vocational nurses (LVN), occupational therapists, and speech therapists
Selecting "No" will reveal the following additional information below:
a. Do you Bill for Services at this location using your Tax ID?–Select Yes or No.
Select "Yes" if you intend to bill for services as an individual
Select "No" if you are not planning on billing but are considering enrollment as an Ordering/Referring/Consulting provider. This enrollment is for individual providers who are not currently enrolled in Texas Medicaid or the Children with Special Health Care Needs (CSHCN) Services Program and who do not currently have an active Texas Medicaid or CSHCN Services Program billing record.
Note: Individual providers who are currently enrolled in Texas Medicaid or the CSHCN Services Program, and who currently have an active Texas Medicaid or CSHCN Services Program billing record can use their current/existing enrollment for ordering/referring services and do not need to obtain an ordering/referring enrollment record.
b. Selecting "No" to the question above will reveal the following additional information:
Select the checkbox acknowledging the following: I understand that in the future if I wish to seek reimbursements for services performed to Medicaid recipients, I must submit a new enrollment application to be eligible for Medicaid billing.
Enter the following provider information for the location you are enrolling into:
Location Name—This name will appear in the practice locations table for each address associated to your enrollment record for quick reference.
Address Line 1—Enter the street address for the practice location where services are performed.
Address Line 2—Enter the suite number or building number information.
City—Enter the city of the location for your practice.
State—Enter the state of the location for your
Zip Code - Enter the ZIP Code of the location for
Zip Code +4—Enter the +4 for the exact location of your practice.
Select Verify Address: Verify that the address that you entered matches the address where services are rendered to clients. You must not enter the accounting, corporate, or mailing address information as the Practice Location, you can provide that information as Additional Address(es) associated to each Practice Location as applicable.
If you require a change to the address, select the checkbox “Click to Change Address”.
Program Participation
Program—Select from the drop-down menu the program in which you are enrolling the practice location.
Primary Taxonomy—Select from the drop-down menu an eligible taxonomy code as provided from the National Plan & Provider Enumeration System (NPPES).
Provider Type—Select from the drop-down menu the provider type that corresponds to the available eligible taxonomy codes provided from the National Plan & Provider Enumeration System (NPPES).
Click Save.
Access the left navigation and select the next available page to continue entering your application.
Instructions for completing the Services Provided section
Select +" Add Services Provided."
This will open the “Location Where Services are Provided” sub-page to determine your enrollment type.
Location Where Services are Provided
Is this a new location? Select Yes or No:
Select "Yes" if:
You are enrolling into a new group location.
Selecting Yes this will reveal the following additional information:.
Group Location – select a location from the available drop-down menu.
If the group has alternate locations, they will be available in the drop-down menu. If not, you will not be able to select a location, and must select No to “Is this a new location”.
If you require changes to the information provided, you will make such changes in sections later within the request.
Select No if:
You are enrolling into an existing group practice location.
Selecting No will reveal the following additional information:
Select an Existing location: Select from the available location within the drop-down menu.
Program Participation
Program: Select from the drop-down menu, the Program for the practice location you are enrolling into.
Primary Taxonomy: Select from the drop-down menu the available list of Eligible Taxonomy codes as provided from NPPES.
Provider Type: Select from the drop-down menu the available list of Provider Type that corresponds to the available list of Eligible Taxonomy codes provided from NPPES.
Click Save.
Access the left navigation and select the next available page to continue entering your application.
This page is not applicable for Performing Provider enrollments. Please continue to the next page.
This page is not applicable for Performing Provider enrollments. Please continue to the next page.
This page is not applicable for Performing Provider enrollments. Please continue to the next page.
This page is not applicable for Performing Provider enrollments. Please continue to the next page.
This page is not applicable for Performing Provider enrollments. Please continue to the next page.
Instructions for completing the Services Provided section
Click Add Services Provided.
This will open the “Location Where Services are Provided” sub-page to determine your enrollment type.
Services Provided Sub-page
Location Where Services are Provided
Is this a new location? Select Yes or No:
Select "Yes" if:
This is a brand-new enrollment, where as the provider is not enrolled in Texas Medicaid.
If you have not enrolled at this exact location before within any Medicaid program.
Selecting "Yes" will reveal Step 3 below.
Select No if:
You have an existing enrollment into a Texas Medicaid and are adding to an existing practice location.
Selecting "Yes" will reveal the following additional information:
Select an existing location—Select from the available locations within the drop-down menu.
Are you a member of a "Group" at this location? – Select No.
Select "No" if:
You are seeking enrollment as an Ordering- or Referring-Only provider.
Selecting "No" will reveal the following additional information below:
a. Do you Bill for Services at this location using your Tax ID?–Select Yes or No.
Select "No" if you are not planning on billing but are considering enrollment as an Ordering, Referring, or Prescribing (ORP) provider. This enrollment is for individual providers who are not currently enrolled in Texas Medicaid or the Children with Special Health Care Needs (CSHCN) Services Program and who do not currently have an active Texas Medicaid or CSHCN Services Program billing record.
Note: Individual providers who are currently enrolled in Texas Medicaid or the CSHCN Services Program, and who currently have an active Texas Medicaid or CSHCN Services Program billing record can use their current/existing enrollment for Ordering, Referring, or Prescribing (ORP) services and do not need to obtain an ordering/referring enrollment record.
b. Selecting "No" to the question above will reveal the following additional information:
Select the checkbox acknowledging the following: I understand that in the future if I wish to seek reimbursements for services performed to Medicaid recipients, I must submit a new enrollment application to be eligible for Medicaid billing.
Enter the following provider information for the location you are enrolling into:
Location Name—This name will appear in the practice locations table for each address associated to your enrollment record for quick reference.
Address Line 1—Enter the street address for the practice location where services are performed.
Address Line 2—Enter the suite number or building number information.
City—Enter the city of the location for your practice.
State—Enter the state of the location for your
Zip Code - Enter the ZIP Code of the location for
Zip Code +4—Enter the +4 for the exact location of your practice.
Select Verify Address: Verify that the address that you entered matches the address where services are rendered to clients. You must not enter the accounting, corporate, or mailing address information as the Practice Location, you can provide that information as Additional Address(es) associated to each Practice Location as applicable.
If you require a change to the address, select the checkbox “Click to Change Address”.
Program Participation
Program—Select from the drop-down menu the program in which you are enrolling the practice location.
Program—Select from the drop-down menu the program in which you are enrolling the Ordering, Referring, or Prescribing (ORP) provider practice location.
Ordering, Referring, or Prescribing (ORP) practice location. Ordering, Referring, or Prescribing (ORP) may enroll in the following programs
Acute Care – -Fee-for-Service
Provider Specialty—-Select from the drop-down menu the provider specialty that corresponds to the available eligible taxonomy codes provided.
Provider Subspecialty—- Select from the drop-down menu the provider subspecialty that corresponds to the available eligible taxonomy codes provided.
Primary Taxonomy—Select from the drop-down menu an eligible taxonomy code as provided from the National Plan & Provider Enumeration System (NPPES).
Provider Type—Select from the drop-down menu the provider type that corresponds to the available eligible taxonomy codes provided from the National Plan & Provider Enumeration System (NPPES).
Click Save.
Access the left navigation and select the next available page to continue entering your application.