New Provider Application Guidance
Updated Provider Application Requirements
Effective September 1, 2015, the Inspector General is required to process new Medicaid enrollment and re-enrollment applications from providers within 10 business days of receiving a complete application. IG will be updating the definition of a complete application in TAC Rule § 371.1003. Please note two important changes:
- Submission of copies of the complete disposition on all criminal history for all individuals required to disclose.
- Submission of documentation of compliance with current board/licensing orders for all individuals required to disclose.
Applications will not be processed until all documentation is provided. To be considered complete, an application must contain:
- Complete answers to all questions, including date of birth, Social Security numbers, license numbers, and all requirements for the provider type defined in the Texas Medicaid Provider Procedures Manual.
- IRS Form W-9 (if required).
- Signed and certified provider agreements.
- Provider Information Form (PIF-1).
- Principal Information Form (PIF-2) on all persons required to be disclosed (if required).
- Full disclosure of all criminal history, including copies of complete dispositions on all criminal history.
- Full disclosure of all board or licensing orders, including documentation of compliance with current board orders.
- Full disclosure of all corporate compliance agreements, settlement agreements, state or federal debt, and sanctions.
- Documentation of an active license. The license expiration date may not be within 30 days of when the application is submitted.
- Completion of a pre-enrollment site visit (if required), and all required current documentation.
- Documentation of fingerprints of a provider and any person with a 5 percent or greater direct or indirect ownership stake in the provider (if required).
For more information, contact the Texas Medicaid and Healthcare Partnership Contact Center, 1-800-925-9126.