Observation Stays No Longer Subject to Concurrent Review

Texas Medicaid Providers—Deadline Approaching for Re-Enrollment/Revalidation

Friday, March 18, 2016

A reminder that the deadline for Texas Medicaid providers to revalidate their enrollments in the Texas Medicaid Program is fast approaching. The deadline is Saturday, September 24, 2016.
 
In January 2016, the Centers for Medicare & Medicaid Services (CMS) extended the revalidation deadline to September 25, 2016, to give the State of Texas additional time to ensure providers comply with Patient Protection and Affordable Care Act (PPACA) requirements. 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. 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.
 
Upcoming Key Dates/Deadlines:
 

  • 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. This means all Texas Medicaid 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 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 remain enrolled in Texas Medicaid as long as the provider continues responding to deficiency notifications within the defined timeframe for response. Continued enrollment is contingent upon meeting deficiency correction timelines and receiving final application approval. Providers are encouraged to 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 as of September 25, 2016, and 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—not 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 all providers participating 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).
 
For more information, please call the TMHP Contact Center at 1.800.925.9126 (select "Option 2") or the TMHPCSHCN Services Program Contact Center at 1.800.568.2413.
 
If you have questions, please email the FirstCare Provider Relations Team at provider_relations@firstcare.com

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