Texas Medicaid service facility NPI requirement
Starting Jan. 1, 2023, we’ll deny claims submitted without a service facility national provider identifier (NPI) number or with a service facility NPI number that is not enrolled and attested through the Texas Medicaid & Healthcare Partnership (TMHP). This applies to services rendered to UnitedHealthcare Community Plan members.
Please see the following requirements for more information:
Service facility NPI required
In accordance with the Texas Medicaid Provider Procedures Manual (TMPPM) and TMHP, the service facility NPI number must be included when billing on a CMS-1500 form for professional services or a UB-04 form for institutional services, or their electronic equivalents.
This requirement applies to your normal service location, as well as services provided outside your normal facility location, such as skilled nursing facilities, labs or hospital settings.
Service locations must be enrolled in Texas Medicaid
The service location entered on the claim is required to be enrolled with Texas Medicaid and you need to enter that information in the Service Facility loop as it is attested with TMHP. You also need to enter the corresponding NPI number that is attested and enrolled for that service facility with TMHP.
If the service location is Place of Service (POS) 11 (office) or 12 (home), the location wouldn’t have a corresponding NPI number enrolled with Texas Medicaid. In this case, the location of the Service Facility must be left completely blank on the claim form (Box 32). If any information is populated, the claim will be denied.
Questions?
If you have questions, contact your Provider Advocate or call Customer Service at 888-887-9003, 8 a.m. – 6 p.m. CT, Monday – Friday. Thank you.
