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.