Observation Stays No Longer Subject to Concurrent Review

Texas STAR Providers—Reminder for Re-Enrollment/Revalidation Deadline of Sept. 25, 2016

Wednesday, June 22, 2016

As mentioned back in January 2016, CMS extended the deadline for Medicaid provider re-enrollment to Sunday, September 25, 2016.
In March, the State of Texas had requested that Medicaid providers apply for re-enrollment no later than Friday, June 17, 2016, to be assured that they would not be dropped from being a Texas Medicaid provider.
Due to the expiration of that deadline, Texas Medicaid will continue to 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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