Avoid disenrollment and submit your re-enrollment forms
today!
With about 45 days to go a provider failing to re-enroll
could face disenrollment as early as Sept. 25, 2016, with possible contract
termination and disruption in claims payment.
As a requirement of the Patient Protection and Affordable
Care Act (PPACA), state Medicaid agencies must revalidate the enrollment of all
providers in state Medicaid programs. The original re-validation deadline was
March 24, 2016, and was extended by the Centers for Medicare and Medicaid
Services (CMS) to allow states additional time to process provider
applications. For Texas Medicaid, this means all providers, including ordering
and referring providers, who have not met all PPACA revalidation requirements
must do so through re-enrollment by Sept. 24, 2016 (see resources at the bottom
of this article for information on how to verify your re-enrollment
status).
To avoid potential disruption in payment, a complete
re-enrollment application must be received on or before June 17, 2016 in order
to be re-validated by Sept. 24, 2016. For Texas Medicaid, this means all
providers, including ordering and referring providers, who have not met all
PPACA revalidation requirements must do so through re-enrollment by Sept. 24,
2016. Complete applications that are received on or before June 17, 2016,
will most likely complete the re-enrollment process by Sept. 24, 2016. In the event
that the re-enrollment process is not completed by Sept. 24, 2016, and the
provider is still working toward addressing identified deficiencies at that
time, the provider will continue to remain enrolled in Texas Medicaid as long
as the provider continues to respond to deficiency notifications within the
defined timeframe for response. Continued enrollment is contingent upon
continuing to meet deficiency correction timelines and receiving final
application approval. Providers should submit a re-enrollment application to
the state or TMHP today.
Texas Medicaid will normally process complete applications
received on or after June 17, 2016; however, Texas Medicaid cannot guarantee
that those applications will be completely processed by the Sept. 24, 2016
deadline. If final approval on an application received after June 17,
2016 is not completed by Sept. 24, 2016, the provider will be dis-enrolled from
Texas Medicaid. Providers including, but not limited to, ordering and referring
providers, will be dis-enrolled from Texas Medicaid with an effective date of
Sept. 25, 2016 if the application is received after June 17, 2016, and a final
determination on the application is pending. Though these applications will
continue to be processed, a gap in enrollment will exist between Sept. 25,
2016, and the date the application is approved.
Important to note: Providers whose applications are
denied will remain dis-enrolled with an effective date of Sept. 25, 2016.
Providers with a gap in Medicaid enrollment will not be eligible to receive
reimbursement for claims with dates of service during the time the provider is
not enrolled in Texas Medicaid. If the re-enrollment application is approved at
a later date, the re-enrollment date will be the date the application was
approved. The effective date will not be retroactive to the date the provider
was dis-enrolled. Additionally, dis-enrolled providers will not be eligible to
participate in Medicaid managed care organizations (MCOs) or dental maintenance
organizations (DMOs) during the dis-enrolled period.
This re-enrollment requirement applies to providers who
participate in Medicaid managed care, traditional fee-for-service Medicaid
(each active TPI Suffix), the Texas Vendor Drug Program (VDP), and in long term
care services administered through the Texas Department of Aging and Disability
Services (DADS).
Information for Acute Care and Pharmacy/DME providers
re-enrolling through TMHP:
•TMHP Provider Re-enrollment webpage
•TMHP Provider Re-enrollment Application: https://secure.tmhp.com/ProviderEnrollment
•TMHP Provider Re-enrollment FAQs
•Instructions on verifying your re-enrollment compliance
status, as well as the date by which you must next re-enroll.
•Contact a TMHP provider enrollment representative for
assistance at: 1-800-925-9126, Option 2
•TMHP Provider Enrollment Tool Quick Reference Guide
•Submit general re-enrollment question via email or request
a PEP application walk-through at: Provider.Enrollment.Mailbox@tmhp.com
Information for Long Term Care (LTC) only providers with a
DADS Medicaid contract re-enrolling through DADS:
•DADS Re-enrollment webpage
•DADS Provider Re-enrollment Forms
•DADS Provider Re-enrollment FAQs
•Submit questions via DADS Provider Re-enrollment Mailbox: Texas.Medicaid.Enrollment@dads.state.tx.us
Information for Vendor Drug Program (VDP) providers
re-enrolling through VDP:
VDP providers should receive a targeted outreach
communication from the Vendor Drug Program with specific information for this
provider type.
•VDP Re-enrollment webpage
•VDP Re-enrollment Application
•VDP Provider Re-enrollment FAQs
•Submit provider re-enrollment questions via email at: MCD_Pharmacy_Re-Enrollment@hhsc.state.tx.us
Information for Medicaid MCO Long-Term Services and Support
(LTSS) providers - There is a separate enrollment process for these LTSS
providers who bill MCOs and do not have an active DADS Medicaid contract and do
not have a TPI for the same provider type to bill TMHP for acute care services.
These providers are required to re-enroll through the Medicaid MCO LTSS
provider re-enrollment process. LTSS providers who are unaware of their DADS
contract status may contact DADS at: Texas.Medicaid.Enrollment@dads.state.tx.us
to verify contract status and establish next steps.