Programs Required to Enroll

All providers that want to participate in state health-care programs must enroll in Texas Medicaid. This enrollment requirement applies to providers who participate in:

  • Traditional fee-for-service Medicaid (each active TPI Suffix)
  • Long term-care (LTC) services
  • Texas Vendor Drug Program (VDP)
  • Medicaid managed care
  • Ordering- and referring-only providers

Click on the bar below applicable to your entity to view more information about the Texas Medicaid provider enrollment process.

Acute Care and Pharmacy/DME Providers Enrolling through TMHP

LTC-only Providers Enrolling Through HHSC

New LTC Providers Must Enroll in Texas Medicaid

A new applicant that wants to obtain a contract to provide Texas Health and Human Services (HHS) LTC Medicaid services must enroll in Texas Medicaid.

Medicaid LTC applicants must enroll in 1 of 2 ways:

  • Applicants that intend to bill through TMHP for acute care services must enroll through TMHP.
  • Applicants that intend to bill long-term care claims only through TMHP must enroll through HHSC.

Note: Community Care for Aged and Disabled (CCAD) contracts for Adult Foster Care, Emergency Response Services, Home-Delivered Meals and Residential Care are not Medicaid contracts.

If Enrolling in Texas Medicaid through TMHP

Applicants that enroll in Texas Medicaid through TMHP do not have to enroll through HHSC; however, these applicants must mail HHSC a copy of TMHP's notification letter as proof of enrollment. The notification letter must state HHSC has approved the application to become a Texas State Health-Care Programs provider and the enrollment term must be current. Applicants should retain the original notification letter for their records.

If you are applying for a Community Services contract (except as noted below), mail copy of TMHP notification letter to:

Texas Health and Human Services Commission
Contracted Community Services
Mail Code W-357
P.O. Box 149030
Austin, TX 78714-9030

If you are applying for a Home and Community-based Services (HCS) or Texas Home Living (TxHmL) contract, mail copy of TMHP notification letter to:

Texas Health and Human Services Commission
Contact Administration and Provider Monitoring
Mail Code W-359
P.O. Box 149030
Austin, TX 78714-9030

If you are applying for a nursing facility (NF) services provider agreement, mail copy of TMHP notification letter to:

Texas Health and Human Services Commission
Regulatory Services
Licensing and Credentialing
Mail Code E-342
P.O. Box 149030
Austin, TX 78714-9030

If you are applying for an intermediate care facility (ICF/IID) services provider agreement, mail copy of TMHP notification letter to:

Texas Health and Human Services Commission
Regulatory Services
Licensing and Credentialing
Mail Code E-330
P.O. Box 149030
Austin, TX 78714-9030

HHSC Medicaid Provider Enrollment Processes (LTC-only Billing)

New applicants that do not intend to bill acute care services through TMHP must enroll through HHSC. This includes new applicants that want to obtain a contract to provide community services, nursing facility services and ICF/IID services.

Community Services

New applicants enroll in Texas Medicaid as part of the contract enrollment process. Applicants must complete Form 3681, Community Services Contract Application, Attachment A, Application Fee Payment Form, and the Texas Medicaid application fee payment. These items must be included in the applicant's Community Services contract enrollment application packet. Other forms and documents that also must be included in the contract enrollment application packet are listed on Form 5830, Application Checklist, State Office Enrolled.

For HCS and TxHmL, see Form 5873, HCS/TxHmL Waiver Program Provider Application Packet Checklist.

The mailing address for Community Services contract enrollment application packets (except as noted below), is:

Texas Health and Human Services Commission
Contracted Community Services
Mail Code W-357
P.O. Box 149030
Austin, TX 78714-9030

The mailing address for HCS and TxHmL contract enrollment application packets is:

Texas Health and Human Services Commission
Contract Administration and Provider Monitoring
Mail Code W-359
P.O. Box 149030
Austin, TX 78714-9030

Nursing Facility Services and ICF/IID Services

New NF and ICF/IID applicants enroll in Texas Medicaid in conjunction with the HHSC Regulatory Services licensing process. New applicants must complete and submit Form 3684, Texas Medicaid Provider Enrollment Application, Attachment A, Application Fee Payment Form, and the Texas Medicaid application fee payment. These items must be included in the applicant's application packet for a license from HHSC. Other forms and documents must also be included in the application packet for a license from HHSC. For more information, visit the How To Become a Nursing Facility Provider or the How to Become an ICF/IID Provider webpages at the HHS website.

The mailing address for HHSC license application packets is:
Texas Health and Human Services ARTS
Mail Code 1470
P.O. Box 149055
Austin. TX 78714

Application Fee for LTC Providers Enrolling Through HHSC

Texas Medicaid must comply with 42 CFR §455.460, which requires states to collect an applicable application fee from a prospective or re-enrolling provider. The amount of the application fee is subject to change every calendar year. Each year, the Centers for Medicare & Medicaid Services (CMS) publishes the application fee in the Federal Register 60 days before the new calendar year. The fee for calendar year 2017 is $560. The fee for calendar year 2018 is $569.00.

Payment must be made by check, money order or cashier's check. Do not send cash. Make check or money order payable to "HHSC." Enter "Medicaid Enrollment" on memo line of check. A Texas Medicaid provider enrollment application is applicable to 1 legal entity and 1 IRS tax ID number. An application fee is required for each application submitted.

An application fee is not required if the applicant already has paid the fee to Medicare or another state's Medicaid or CHIP program and has been approved for enrollment in Medicare or another state's Medicaid or CHIP program. Providers will be required to submit proof of enrollment in other programs to HHSC with submission of the enrollment application (see FAQ for LTC Applicants).

Frequently Asked Questions for LTC-only Applicants

What does HHSC Medicaid provider enrollment entail?
Enrollment includes submitting the appropriate Texas Medicaid provider enrollment application form, additional forms and documentation as required for contract enrollment or licensing, and the Texas Medicaid enrollment application fee. Receipt of a complete application packet and the application fee will initiate the provider screening process.

What will the provider screening process entail?
Texas Medicaid providers are screened according to their risk category to fulfill requirements for enrollment as mandated by Section 6401 of the Affordable Care Act (ACA). The Center for Medicare & Medicaid Services (CMS) has established 3 categories of risk: limited, moderate and high. Screening activities associated with each risk category are shown in the table below.

CMS Risk Categories and Screening Activities
Risk Screen Activities
Limited Verification of provider-specific requirements, including:
  • License verification
  • National Provider Identifier (NPI) verification
  • Federal and state database checks
  • Ownership/controlling interest information verification
Moderate

All screening activities for limited risk providers

Unannounced site visits before and after enrollment or re-enrollment

High

All screening activities for limited and moderate risk providers

Submission of fingerprints for all individuals with ownership in the entity of 5 percent or more

HHSC Contracted Community Services (CCS) leverages site visits performed by HHSC Regulatory Services survey operations staff to comply with ACA site visit requirements. HHSC CCS also leverages site visits performed by CCS contract monitoring staff. A pre-enrollment site visit is required for unlicensed entities.

HHSC CSS leverages criminal history background checks performed by HHSC Regulatory Services licensing staff to comply with ACA fingerprint submission requirements for high risk providers.

I have already paid an application fee to enroll in Medicare. What will HHSC accept as my proof of payment?

HHSC will accept a CMS approval letter for either your application to enroll in Medicare or your application for revalidation. Your Medicare enrollment term must be current. HHSC will also accept a receipt for payment from the PECOS system or a pay.gov email as proof of payment.

Information for VDP Providers Enrolling through VDP

There is a separate enrollment process for pharmacy providers. Pharmacies that wish to participate in Texas Medicaid must enroll with the Vendor Drug Program (VDP) before providing outpatient prescription services or participating in a managed care network.

Email provider enrollment questions to: MCDPharmacyContractManage@hhsc.state.tx.us.

Medicaid MCO Long-Term Services and Support (LTSS) Providers

HHSC has begun the Affordable Care Act Managed Care Organization (MCO) Long Term Services and Supports (LTSS) provider enrollment process. MCO LTSS providers are required to enroll through the Medicaid MCO LTSS provider enrollment process no later than Jan. 1, 2018.

MCO LTSS providers not enrolled by the deadline may be disenrolled from the program. To allow sufficient time for application processing, MCO LTSS providers are strongly advised to submit applications as soon as possible to avoid disruptions.

MCO LTSS providers are providers who are assigned an Atypical Provider Identifier (API) by HHSC, do not have an active Texas Provider Identifier (TPI) for the same provider type to bill TMHP for acute care services and do not have an active DADS Medicaid contract.

MCO LTSS providers may obtain an application by submitting a request to MCO_LTSS_Provider_Re-Enrollment@hhsc.state.tx.us. The request must include the provider's business name, tax identification number and National Provider Identifier. Questions or concerns may also be submitted to this email box.

Ordering- and Referring-only Providers

Due to the impact of Hurricane Harvey, and pending clarification from the Centers for Medicare & Medicaid Services, the Texas Health and Human Services Commission delayed implementing required enrollment of all ordering, referring or prescribing providers which initially was scheduled to happen in October.

Beginning Jan. 15, 2018, claims for the payment of items and services ordered, referred or prescribed must contain the National Provider Identifier of the physician or other professional who ordered, referred or prescribed the items or services. In addition, all ordering, referring or prescribing providers must enroll in Texas Medicaid as participating providers.

These requirements affect Medicaid, Healthy Texas Women and the Children with Special Health Care Needs Services Program only. However, these requirements don’t apply to out-of-network providers who order, refer or prescribe only for managed care members.

HHSC is allowing a three-month grace period from Jan. 15, 2018, to April 16, 2018, during which it will deny claims not meeting these requirements, and then reprocess them to allow providers more time to complete enrollment and minimize client and provider impact.

The Ordering, Referring, and Prescribing Providers Frequently Asked Questions (PDF) document is now available on the TMHP website.

Except for out-of-network providers who order items or services for managed care members, all providers who order, refer or prescribe for clients enrolled in Medicaid, HTW or the CSHCN Services Program should begin the enrollment process immediately by completing the application on the TMHP website.