Deadline Approaching: Avoid Medicaid Provider Disenrollment
Written by Editor   
Thursday, March 17, 2016 12:00 AM

This is a reminder that this Friday, June 17, 2016 is the Texas Medicaid deadline for submission of a re-enrollment (revalidation) application in order to ensure continued enrollment in Texas Medicaid on the federal deadline of September 24, 2016. 

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 the CMS deadline of September 24, 2016.  Complete applications that are received on or before June 17, 2016, will most likely complete the re-enrollment process by September 24, 2016. In the event that the re-enrollment process is not completed by September 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.

If the provider's re-enrollment application is not received on or before June 17, 2016, there is not a guarantee that the re-enrollment application will complete the process to meet the September 24, 2016 deadline.  If the provider's re-enrollment application is not processed by September 24, 2016, the provider will be dis-enrolled from Texas Medicaid with an effective date of September 25, 2016.

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 September 24, 2016 (see resources at the bottom of this article for information on how to verify your re-enrollment status).

To avoid disenrollment on September 25, 2016, and possible disruption in claims payment, providers should submit a re-enrollment application to the state or TMHP today.

Applications Received On or Before June 17, 2016

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 September 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 September 24, 2016. Complete applications that are received on or before June 17, 2016, will most likely complete the re-enrollment process by September 24, 2016. In the event that the re-enrollment process is not completed by September 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.

Applications Received After June 17, 2016

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 September 24, 2016 deadline. If final approval on an application received after June 17, 2016 is not completed by September 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 September 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 September 25, 2016, and the date the application is approved. Providers whose applications are denied will remain dis-enrolled with an effective date of September 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.

Programs Required to Re-enroll

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 Application: https://secure.tmhp.com/ProviderEnrollment
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