Observation Stays No Longer Subject to Concurrent Review

Medicaid/CHIP—Current CHIP Providers Must Complete Enrollment with TMHP by 12/31/17 to Continue to Receive Reimbursement for CHIP Services

Friday, May 5, 2017

Federal law and regulation require states to screen and enroll all network providers including Children’s Health Insurance Program (CHIP) providers by December 31, 2017. To meet this requirement and continue receiving reimbursement for services, providers who currently render services to CHIP members through a managed care organization (MCO) must complete enrollment with the Texas Medicaid & Healthcare Partnership (TMHP) by December 31, 2017.
 
While the enrollment process and application are the same for Medicaid and CHIP providers, CHIP-only providers are not required to participate in Texas Medicaid. CHIP-only providers must follow the instructions below to indicate they intend to serve only CHIP members and to ensure that they do not appear on the Medicaid online provider lookup (OPL).
 
Note: CHIP providers actively enrolled with TMHP as a Medicaid provider do not need to repeat the enrollment process to continue to receive reimbursement for CHIP services.
 
Enrollment Information Specific to CHIP Providers
 
Beginning July 1, 2017, providers can indicate in the enrollment application that they intend to serve only CHIP members. Providers must document this appropriately to ensure they are not displayed as a Medicaid provider on OPL.
 
CHIP providers are encouraged to enroll using the Provider Enrollment on the Portal (PEP). Additionally, the Provider Information Management System (PIMS) will be updated with options for providers to designate that they intend to serve only CHIP members.
 
Providers should begin the enrollment process as soon as possible. The PIMS update will allow providers who start the enrollment process before these updates occur, to designate themselves as CHIP-only providers on the OPL after they are enrolled.
 
For more information, providers should visit the upcoming CHIP webpage that will be added to TMHP.com in the next few weeks.
 
For more information, call the TMHP Contact Center at 1-800-925-9126. 

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