Medicaid Provider Enrollment

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 services
  • Texas Vendor Drug Program 
  • 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 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 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 or Texas Home Living 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 services provider agreement, mail copy of TMHP notification letter to:

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

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

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

For more information about the Medicaid Provider Enrollment Process for LTC-only Billing, please click here.

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 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 Providers

An extension to the deadline for LTSS providers serving managed care members (“MCO LTSS providers”) required to enroll through the Medicaid MCO LTSS provider enrollment process has been extended to February 1, 2019.

To allow sufficient time for application processing, MCO LTSS providers are strongly advised to submit applications as soon as possible.  LTSS providers who have not either started or completed the enrollment process and are still billing the MCOs will receive the letter below and should take immediate action in order to meet the February 1, 2019, enrollment deadline.

An MCO LTSS provider is any provider who provides LTSS services under a specific NPI and taxonomy combination and submits claims through Medicaid Managed Care. An MCO LTSS provider will have to enroll through this process when the NPI and taxonomy combination they bill LTSS services with does not have an active, associated TPI through TMHP or an API through this process.

MCO LTSS providers, must complete the enrollment process by the deadline to be able to provide services and submit claims to the MCOs for payment consideration. Please reference the attached the Quick Tips document and the LTSS Taxonomies document.

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, taxonomy and National Provider Identifier.

MCO LTSS Master Provider File

Effective December 1, 2018, HHSC will resume uploading the LTSS Master Provider File in a text format to a central location, MCODATA folder, on TexMedCentral for all MCOs to retrieve on Mondays. The LTSS Master Provider File will no longer be uploaded to each MCO’s XXXLIB folders. Please refer to the LTSS Master Provider File JIP examples attached in the below LTSS MPF_MCO and HHSC Procedures document. This document gives an overview of the LTSS Master Provider File process:

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.