May 01, 2022

Texas Medicaid claims: Service facility National Provider Identifier requirement

The Texas Medicaid & Healthcare Partnership (TMHP) requires the service facility to include their National Provider Identifier (NPI) on these claim submissions forms or their electronic equivalents:

  • CMS-1500 for professional services
  • UB-04 for institutional services

This requirement applies to claims submitted for services administered at your practice and at other locations, such as skilled nursing facilities, labs and hospital settings.

Leave the NPI field and service facility blank only in the following scenarios:

  • If the service location is the member’s home, in which case the NPI is nonapplicable
  • If the service facility is the same as the billing provider’s location. Please note that if any part of the service facility is filled out, you must complete all the fields, including NPI, or we will deny the claim.

Medicaid enrollment reminder
Please enroll your service location and NPI with Texas Medicaid on TMHP Provider Enrollment. When you submit claims, the service location and NPI entries must exactly match what you entered and attested to in your enrollment, or your claim will be denied.  

Questions?
For more information on filing claims, go to UHCprovider.com/manuals and scroll down to Texas for a selection of provider manuals. Review the TMHP Medicaid Provider Manual for TMHP claim requirements, including definitions for attending and rendering providers. Please reach out to your Provider Advocate at 888‑887‑9003, 8 a.m.–6 p.m., Monday–Friday, if you have questions. 

PCA-22-01159-C&S-News