As part of Federal Regulation (Code of Federal Regulations 455.432), Texas Medicaid & Healthcare Partnerships (TMHP) may conduct a scheduled or unscheduled post-enrollment site visit for providers who are designated as “moderate” or “high” risk. The purpose of a post-enrollment site visit is to verify that providers are in compliance with federal and state enrollment requirements.
During the unscheduled and unannounced pre-enrollment site visits, an audit will be performed to ensure that prospective providers meet enrollment requirements. During post-enrollment site visits, an audit will be performed to ensure that current providers remain operational and continue to meet required provider standards. Failure to comply may result in denial and or termination of a provider’s Medicaid contract.
For more information about Affordable Care Act Provider Enrollment, providers can refer to the Affordable Care Act (ACA) Provider Enrollment Frequently Asked Questions (FAQ) document.
For more information, call the TMHP Contact Center at 1-800-925-9126.