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 HHS CCS or DADS

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 the Texas Department of Aging and Disability Services (DADS) or HHS Contracted Community Services (CCS).

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 DADS or HHS CCS; however, these applicants must mail DADS or HHS CCS 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
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
Contracted Community Services
Mail Code W-359
P.O. Box 149030
Austin, TX 78714-9030

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

Texas Department of Aging and Disability Services
Regulatory Services
Licensing and Credentialing
Mail Code E-342
P.O. Box 149030
Austin, TX 78714-9030

DADS and HHS CCS Medicaid Provider Enrollment Processes (LTC-only Billing)

New applicants that do not intend to bill acute care services through TMHP must enroll through DADS or HHS CCS. 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 of $560. 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
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
Contracted Community Services
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 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 of $560. These items must be included in the applicant's application packet for a license from DADS. Other forms and documents must also be included in the application packet for a license from DADS. 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 DADS 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 HHS CCS or DADS

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.

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 DADS or HHS CCS with submission of the enrollment application (see FAQ for LTC Applicants).

Frequently Asked Questions for LTC-only Applicants

What does DADS and HHS CCS 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

DADS and HHS CCS leverage site visits performed by DADS Regulatory Services survey operations staff to comply with ACA site visit requirements. HHS CCS also leverages site visits performed by CCS contract monitoring staff. A pre-enrollment site visit is required for unlicensed entities.

HHS CSS leverages criminal history background checks performed by DADS 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 DADS or HHS accept as my proof of payment?
DADS and HHS CCS 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. DADS and HHS CCS 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 must submit an enrollment application no later than July 1, 2017; however, MCO LTSS providers are strongly advised to submit applications before July 1, 2017.

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

Ordering- and referring-only providers are those providers whose only relationship with Texas Medicaid is ordering or referring services for Medicaid clients. These providers are now required to enroll with Texas Medicaid as participating providers.

Click here if you need a paper application.

Information for Ordering and Referring-Only providers